Endovascular therapy for superior vena cava syndrome: A systematic review and meta-analysis

Abdul Hussain Azizi; Irfan Shafi; Matthew Zhao; Saurav Chatterjee; Stephanie Clare Roth; Maninder Singh; Vladimir Lakhter; Riyaz Bashir

doi:10.1016/j.eclinm.2021.100970

Endovascular therapy for superior vena cava syndrome: A systematic review and meta-analysis

EClinicalMedicine. 2021 Jun 28:37:100970. doi: 10.1016/j.eclinm.2021.100970. eCollection 2021 Jul.

Authors

Abdul Hussain Azizi¹, Irfan Shafi², Matthew Zhao³, Saurav Chatterjee⁴, Stephanie Clare Roth⁵, Maninder Singh⁶, Vladimir Lakhter⁶, Riyaz Bashir⁶

Affiliations

¹ Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
² Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, United States.
³ Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
⁴ Division of Cardiology, Department of Medicine, Northshore-LIJ Hospitals of Northwell Health, and Assistant Professor of Medicine, Zucker School of Medicine, New York, NY, United States.
⁵ Ginsburg Health Sciences Library, Temple University, Philadelphia, PA, United States.
⁶ Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.

Abstract

Background: Superior vena cava (SVC) syndrome is caused by the obstruction of the SVC and can result in significant morbidity and mortality. In contemporary practice, endovascular therapy (ET) has become the standard of care for a majority of these patients. This study is a systematic review and meta-analysis of the available literature to assess technical success, restenosis, and recurrence of SVC syndrome following endovascular intervention.

Methods: For this meta-analysis, we conducted a systematic literature review of PubMed, Cochrane Library, and Embase databases from inception to April 14, 2021 for studies on ET for SVC syndrome. Studies included full-length journal articles on the use of ET among adults with SVC syndrome. Case reports or case series with fewer than 20 patients were excluded. We evaluated the endpoints of technical success rate, restenosis rate, and recurrence rates in SVC syndrome patients after endovascular stenting. The results of this study were calculated using random-effects models.

Findings: We identified 6,012 reports, of which 39 studies met our inclusion criteria and were included for analysis. A total of 2200 patients received ET for SVC syndrome. The weighted technical success rate was 98.8% (95% CI 98.2-99.3) with low heterogeneity (I²=17.4%, p = 0.185), restenosis rate was 10.5% (95% CI 8.4-12.6) with moderate heterogeneity (I²=53.5%, p<0.001), and recurrence rate was 10.8% (95% CI 8.1-13.5) with high heterogeneity (I²=75.8%, p<0.001). Total complication rate was 8.6% (95% CI 7.3%-9.9%) with a mean complication rate of 7.5% (95% CI 4.7%-10.3%).

Interpretation: Our systematic review revealed high technical success, low restenosis, and low recurrence rates following ET. Collectively, these results support the paradigm of ET as an effective and safe treatment for patients with SVC syndrome.

Funding: None.

Keywords: Angioplasty; Catheter-directed thrombolysis; Endovascular therapy; Stents; Superior vena cava syndrome.