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Unusual Migration of a Vena Cava Stent into the Pulmonary Artery Because of Tumor Reduction after Chemotherapy

      A 47-year-old woman with superior vena cava syndrome (SVCS) presented a metastatic small-cell lung cancer (SCLC). An initial computed tomography revealed a large tumor of the right lung, compressing the superior vena cava (Fig. 1A). A vena cava stent was inserted at the time of diagnosis and the patient was sent for chemotherapy. After the patient was administered four courses of chemotherapy by cisplatin and etoposide, the computed tomography revealed a partial tumor response (Fig. 1B) and migration of the stent into the left pulmonary artery (Fig. 2). Because of the poor oncological prognosis and the asymptomatic character of the migration, surgery was not indicated. Anticoagulation treatment was challenged because of the risk of hemorrhage. The patient died 3 months later because of a hepatic encephalopathy.
      Figure thumbnail gr1
      FIGURE 1A, Initial chest CT scan showing vena cava stenosis caused by a mediastinal mass (arrow). B, Chest CT scan showing a normal diameter of vena cava after four courses of chemotherapy (arrow). CT, computed tomography.
      Figure thumbnail gr2
      FIGURE 2A, CT scan: coronal reconstruction with projection of the prosthesis at the dome of the left pulmonary artery (arrow). B, CT scan: horizontal section with a thrombosed prosthesis obstructing the the left lower lobe artery (arrow). CT, computed tomography.
      Migration of an endoprosthesis can lead to potentially serious complications and is estimated at 3%
      • Wilson LD
      • Detterbeck FC
      • Yahalom J
      Superior vena cava syndrome with malignant causes.
      ,
      • Nguyen NP
      • Borok TL
      • Welsh J
      • Vinh-Hung V
      Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome.
      Some authors suggest that the vena cava stent should be avoided in patients with SCLC because of the chemo- and radiosensitive nature of this histologic type of cancer, which increases the risk of stent migration because of rapid tumor shrinkage under treatment.
      • Wilson LD
      • Detterbeck FC
      • Yahalom J
      Superior vena cava syndrome with malignant causes.
      In some cases of acute SVCS spectacular clinical results could be observed during the 24 to 48 hours after insertion of the stent, whereas the efficacy of chemotherapy or radiotherapy was not observed until 3 to 4 weeks after.
      • Nguyen NP
      • Borok TL
      • Welsh J
      • Vinh-Hung V
      Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome.
      ,
      • Greillier L
      • Dutau H
      • Astoul P
      [Specific emergencies in thoracic oncology: pleurisy, superior vena cava syndrome, and tracheobronchial obstruction].
      The insertion of a vena cava stent must be avoided in SVCS caused by SCLC.
      • Nguyen NP
      • Borok TL
      • Welsh J
      • Vinh-Hung V
      Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome.

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        Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome.
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