This protocol addresses malignant inferior vena cava syndrome (IVCS) — a clinically distinct entity from benign IVCS — in which tumor compression or direct invasion of the inferior vena cava produces venous obstruction.
Malignant IVCS occurs across a broad range of primary tumors and metastatic presentations: renal, adrenal, pancreatic, hepatocellular, ovarian, cervical, and prostatic carcinomas, gastric cancer, pheochromocytomas, retroperitoneal sarcomas, pelvic or retroperitoneal lymph node metastases, and primary lymphomas.
The cornerstone intervention in this setting is venous stenting, combined with perioperative medical co-treatment. Specific device selection, procedural parameters, antiplatelet and/or anticoagulation regimen, and the criteria that guide patient selection are detailed in the full protocol.
DOI: 10.1024/0301-1526/a000919
Benign IVCS is separated from malignant IVCS.
Malignant IVCS was described in patients with renal carcinomas, adrenal carcinomas, pheochromocytomas, pancreatic carcinomas, hepatocellular carcinomas, ovarian carcinomas, cervical carcinomas, prostatic cancer, gastric cancer, retroperitoneal sarcomas, metastatic malignant disease involving the pelvic and retroperitoneal lymph nodes, and primary lymphomas.
Stenting in malignant IVCS is indicated: (1) in patients with severe symptoms (2) in case of persistency of symptoms despite radio- and/or chemotherapy, and (3) in patients in whom chemotherapy and radiation are contraindicated or of minor effectiveness.
Obviously, the Wallstent and the Cianturco-Z-Stent are most frequently used.
Nevertheless, most centers prefer at least a short-term antiplatelet and/or anticoagulation treatment regime.
Stent therapy in tumor patients provides rapid symptomatic relieve within hours to days and does not interfere with biopsy.
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