Palliative Venous Stenting for Malignant Obstructions
Peri-vascular tumors can occasionally invade a vessel lumen resulting in vascular occlusion and peripheral edema (e.g. vena cava obstruction), ascites (e.g. portal hypertension due to hepatic vein obstruction), or both. Examples include vascular sarcomas and adrenal tumors. Self-expanding metallic stents can be placed under fluoroscopic guidance across malignant obstructions to relieve vascular occlusions and reduce venous congestion resulting in profound clinical improvement (Figure 13).
Figure 13. Palliative stenting for malignant venous obstruction leading to hepatic congestion, portal hypertension, severe ascites, and hind limb edema. (Pre-Stenting) Percutaneous transjugular catheterization of left hepatic vein (HV) and caudal vena cava (CVC). Simultaneous DSA of HV and CVC demonstrate large filling defect (Tumor) at junction of left HV and CVC resulting in severe distension of HV and CVC caudal to the tumor. (Post-Stenting) Simultaneous DSA through both catheters immediately following self-expanding metallic stent (Stents) placement within the left HV and CVC demonstrating recanalization and decompression of both veins.