Endovascular treatment of superior vena cava syndrome utilizing an iliac branch endoprosthesis

Endovascular therapy is the preferred treatment for superior vena cava (SVC) syndrome, providing rapid symptom relief and high technical success. Lesions involving the confluence of the bilateral innominate veins and SVC, however, remain challenging due to complex anatomy and limited durability of standard stents. This case series describes the off-label use of the Gore Iliac Branch Endoprosthesis (IBE) for reconstruction of the SVC confluence in four patients with SVC syndrome: three with malignant etiologies and one with benign catheter-associated thrombosis. Technical success was achieved in all patients, with immediate restoration of venous flow and symptom resolution. In malignant cases, patency was maintained until death from cancer at 5–20 months. The benign case demonstrated durable patency and complete symptom relief at 18-month follow-up. No procedural complications or early device failures occurred. The Gore IBE offers a feasible approach for anatomic reconstruction of the SVC confluence, accommodating bilateral venous inflow while maintaining luminal integrity. This technique may overcome limitations of parallel stenting, providing durable symptom relief in both malignant and benign SVC syndrome. Further investigation is warranted to evaluate long-term outcomes and broader applicability.