A Single-Center Review of Clinical Outcomes After Transcatheter Relief of Superior Vena Cava Stenosis in a Pediatric and Young Adult Population

Background: The suspected etiology of superior vena cava (SVC) obstruction is predominantly iatrogenic. Transcatheter interventions relieve stenosis with good long-term results, although there is a paucity of published data in pediatrics. We aim to describe patient characteristics and clinical outcomes after transcatheter SVC intervention at a single-center pediatric quaternary care center.

Methods: Single-center, retrospective study of all pediatric and young adult patients who underwent transcatheter SVC intervention from December 2006 to January 2020. SVC gradients and changes in vessel diameter were compared using paired-sample t-tests. Balloon and stent cohorts were compared using the Wilcoxon rank sum test or Fisher exact χ² test. Reintervention was compared between balloon and stent cohorts using the McNemar test to determine if initial procedural type was associated with reintervention. Time to reintervention was compared between balloon vs stent cohorts using Kaplan-Meier survival analysis with a log-rank test.

Results: A total of 42 patients (median age, 1.5 years; IQR, 0.31-15; 64.2% male) underwent 81 procedures with 1 minor complication and no mortality attributed to the procedure. Most (71.4%) patients were asymptomatic. Affected patient subgroups include those with a history of central venous line (92.9%), congenital heart disease (76.2%), postorthotopic heart transplant (42.9%), post-ECMO (31.0%), and history of surgical baffling or SVC surgery (9.5%). Those who underwent initial balloon angioplasty were significantly younger and smaller than those with an initial stent. Significantly lower pressure gradients and larger SVC dimensions were achieved after stenting. The majority of patients (54.8%) resolved after initial balloon angioplasty and reintervention rates were similar between initial balloon angioplasty and stent, although reintervention trended toward being earlier after the balloon.

Conclusions: Transcatheter SVC intervention in pediatrics is acutely effective and safe in relieving SVC obstruction in all subgroups. Reintervention rates are similar between balloon and stenting, with balloon tending to be earlier, with the majority resolving after initial intervention. Further research is necessary to investigate the most effective transcatheter intervention for each patient subgroup.