Endovascular interventions in cancer patients with compromise of the mediastinal vasculature: a review

The mediastinal vasculature can be affected by various etiologies in cancer patients. Both direct and indirect sequela of cancer may result in life-threatening clinical presentations. Tumor growth may cause vessel narrowing and decreased blood flow from either extrinsic mass effect, invasion into the vascular wall, or tumor thrombus within the lumen. In addition, cancer patients are predisposed to indirect sequela to the mediastinal vasculature from an increased risk of benign thromboembolic events, tumor thrombus, or iatrogenic complications during cancer treatments. Benign thrombus may result in partial or complete occlusion of the superior vena cava (SVC) or pulmonary artery. Vascular damage such as pseudoaneurysm or stricture may result from iatrogenic complications from radiation therapy, surgery, or other interventions. The clinical presentation of the vascular compromise is dictated by the vascular anatomical structure that is affected and the type of injury. In the appropriate clinical scenario, endovascular treatments may be pursued. These minimally invasive procedures include balloon venoplasty and angioplasty, stent placement, catheter-directed thrombolysis, embolectomy, and embolization. This review discusses the most common endovascular interventions for vascular compromise based on the great vessel affected: the SVC, pulmonary artery, pulmonary vein, bronchial arteries, or the aorta and supra-aortic arteries. Indications for treatment are discussed, with particular attention to disease etiology and clinical presentation.