Superior vena cava (SVC) stent placement in children and young adults with congenitally normal cardiac and caval anatomy.

Abstract

Background: Reports of child and young adult superior vena cava (SVC) stent placement, safety, and long-term patency are limited, particularly in children without congenital heart defects (CHDs).

Objective: To characterize technical success, safety, and long-term outcomes of SVC stent placement in children and young adults without co-existing congenital heart defects. Additionally, to demonstrate the ability of SVC stent placement to maintain central venous access in patients with difficult access.

Materials and methods: Institutional Review Board (IRB) approved retrospective review of children and young adults without CHDs who underwent SVC stent placement between 2014 and 2024 was performed. SVC stenosis/occlusion was determined by pre-procedure imaging (chest computed tomography (CT) or magnetic resonance imaging (MRI)), and confirmed with venography and intravascular ultrasound. Symptomatic patients were defined as patients with facial or neck swelling, bulging neck or chest wall collaterals, and dependence on central venous access with narrowed or occluded central venous pathways.

Results: Nineteen patients (n = 11 F, n = 8 M) without CHDs had SVC stents placed. All had SVC stenosis or occlusion secondary to chronic central venous access. Mean age was 16.5 years (3 - 20 years, interquartile range 7.375 years) and mean weight was 50 kg (15.8 - 115.2 kg, interquartile range 32.6 kg). Ten percent (2/19) presented with acute SVC syndrome. In total, 21% (4/19) required sharp recanalization. Twenty-four total stents were placed; 21 (88%) were bare metal and three were covered. One major complication of SVC tearing occurred during sharp recanalization, which led to hemopericardium/cardiac tamponade. This complication was successfully treated with a pericardial drain and deployment of a second stent across the vessel injury. Median patient follow-up time was 15 months (0.5-88 months, interquartile range 53 months). Seventy-four percent (15/19) had imaging follow-up (chest CT or venography) to assess stent patency, with a mean imaging follow-up of 11 months (3 days-86 months, interquartile range 11 months). Three patients required re-intervention(s): two required venoplasty to allow for catheter exchange, and one required venoplasty for recurrent facial and upper extremity swelling. The mean time to re-intervention was 16 months (2-28). There were no complications during repeat interventions. All patients maintained central venous access for the duration of required treatment or throughout the entire study period.

Conclusion: SVC stent placement in children and young adults without CHDs has a favorable safety profile and is an effective solution for preserving critical central venous access for necessary therapy in chronically ill children.