Management of malignant inferior vena cava syndrome (IVCS) by endovascular bridging stent placement

A 73-year-old male patient was admitted to the emergency department with dyspnea and severe edema in the lower extremities. The patient had been diagnosed with extensive small-cell lung cancer 15 months previously. Contrast-enhanced CT revealed suprahepatic compression of the inferior vena cava (IVC) at the level of its entry into the right atrium, caused by a space-occupying, infiltrating right lung lesion. Inferior vena cava syndrome (IVCS) occurs after obstruction of venous flow through the IVC. Trunk and lower limb edema are the most common manifestations of this syndrome, whereas cardiac function may be compromised in more severe cases. Given the patient's performance status, disease stage, and symptom acuity, endovascular stenting of the IVC was preferred over surgery or radiotherapy. The superior vena cava (SVC)-to-IVC bridging stent approach was employed to address the severe mass effect and location of the IVC stenosis at its junction with the right atrium. Three uncovered self-expandable stents were deployed in tandem from the SVC to the IVC. Overlap between stents minimized the risk of collapse within the right atrium, possibly leading to cardiac conduction disorders or even perforation of the heart wall. The patient experienced alleviation of IVCS symptoms over the next 48 h but unfortunately passed away 8 days later from his primary disease. Although primarily palliative in oncologic cases, SVC-to-IVC stenting can offer rapid and safe relief of symptoms in patients with advanced oncologic disease by restoring venous return to the heart.