Avtor/Urednik		Vodvarka, Pavel; Štverak, Petr
Naslov		Algorithm for percutaneous stenting in patients suffering from superior vena cava syndrome
Prevedeni naslov		Algoritem zdravljenja sindroma zgornje vene cave s perkutanim stentom
Tip		članek
Vir		Radiol Oncol
Vol. in št.		Letnik 34, št. 4
Leto izdaje		2000
Obseg		str. 349-55
Jezik		eng
Abstrakt		Background. Superior vena cava syndrome (SVCS) has been considered an emergent, life-threatening condition for a long time. The rate of causes of the syndrome has changed substantially since its first description by W. Hunter in a patient suffering from saccular aneurysm of syphilitic aorta in 1757. Since the beginning of the era of radiotherapy, this was the main treatment modality for patients with SVCS. The emergent feature of the syndrome required immediate initiation of radiotherapy, often without the proper knowledge of the histopathological diagnosis of the SVCS underlying cause. The development of radiotherapy and chemotherapy in various types of cancer, and the development of supportive care in oncology and an understanding that SVCS is not an emergent life-threatening oncological condition evoked a need for treatment differentiation in SVCS patients. Conclusions. Percutaneous stenting become a very efficient method in the treatment of SVCS patients since 1986. The purpose of stenting is supportive and/or palliative. The algorithm for stenting use has been developed. Algorithm is based on 4 questions emerging from daily clinical practice. To get valid responses, certain diagnostic procedures and tools are recommended and required. 1. Does the patient really suffer from SVCS? 2. What is the patients general condition? 3. Is the stenting of SVCS contraindicated? (What is the origin of SVCS, what is the severity of SVCS?) 4. Is the histopathology of the process causing SVCS known? What is the histopathology of the process causing SVCS? Responses to the questions above give reasons for the selection of a treatment modality. Ration usage of percutaneous implantable stents in properly chosen patients suffering from SVCS of malignant ethiology ensures efficient differentiation of treatment modalities in supportive and/or palliative care of SVCS patients.
Izvleček		Sindrom zgornje vene cave je dolgo veljal za življensko nevaren bolezenski pojav. Od leta 1757, ko je W. Hunter prvič opisal ta pojav pri bolniku s sakularno anevrizmo sifilitične aorte, je bilo odkritih veliko zelo različnih vzrokov tega sindroma. Uporaba perkutanega stenta je z razvojem radioterapije postala osnovni in glavni način zdravljenja bolnikov s sindromom zgornje vene cave. Nenaden pojav tega sindroma je zahteval takojšnje zdravljenje z radioterapijo, četudi histopatološka preiskava še ni potrdila vzroka sindroma. Z razvojem radioterapije, kemoterapije in pomožnega zdravljenja raznih vrst raka ter hkrati s spoznanjem, da sindrom zgornje cave ni vedno življensko nevaren, je zaradi različnega načina zdravljenja bolnikov s sindromom zgornje vene cave postalo nujno ločevati bolnike med seboj. Zaključki. S perkutanim stentom že od leta 1986 učinkovito zdravimo bolnike s sindromom zgornje vene cave. Zdravljenje s perkutanim stentom uvajamo kot pomožno ali kot paliativno zdravljenje. Razvili smo tudi algoritem tega zdravljenja, ki temelji na štirih vprašanjih, osnovanih na kliničnih izkušnjah. Če hočemo, da bi bili odgovori veljavni, moramo uporabiti določene diagnostične postopke in orodja, ki ustrezajo priporočilom in zahtevam. 1. Ali se je pri bolniku zares razvil sindrom zgornje vene cave? 2. Kakšno je splošno fizično stanje bolnika? 3. Ali so bile ugotovljene kontraindikcije, ki pri zdravljenju sindroma zgornje vene cave ne dovoljujejo uporabe stenta? 4. Ali so znani rezultati histološke preiskave procesa, ki je povzročil sindrom? Kakšni so rezultati histološke preiskave procesa, ki je povzročil sindrom? Odgovori na zgornja vprašanja odločajo o izbiri načina zdravljenja. Tako dosežemo racionalno uporabo perkutanih vstavljivih stentov pri bolnikih s sindromom zgornje vene cave z maligno etiologijo, ki potrebujejo pomožno zdravljenje in/ali paliativno zdravljenje.
Deskriptorji		SUPERIOR VENA CAVA SYNDROME STENTS PRACTICE GUIDELINES