Results of intravascular stent placement for fibrosing mediastinitis.

Published on Mar 1, 2010in Congenital Heart Disease1.663
· DOI :10.1111/J.1747-0803.2010.00387.X
Matthew E. Ferguson1
Estimated H-index: 1
,
Allison K. Cabalka30
Estimated H-index: 30
+ 1 AuthorsDonald J. Hagler72
Estimated H-index: 72
(Mayo Clinic)
Sources
Abstract
Objective.  Fibrosing mediastinitis is a rare disorder characterized by an excessive fibrotic reaction in the mediastinum which can result in compromise of mediastinal structures. We sought to evaluate short- and midterm results of intravascular thoracic vessel stent placement for patients with fibrosing mediastinitis. Design.  We reviewed all records of fibrosing mediastinitis patients who were referred for stent placement to treat mediastinal vascular compression over a 7-year period. Catheterization reports and digital angiography were assessed to determine vessel dimension and stent characteristics. Patients.  Thirteen catheterizations were performed in six patients (five females, mean age 39 years, range 23–63) with a range of 1–4 per patient. Interventions.  Four patients were treated with intravascular stents placed percutaneously. One patient underwent surgical intravascular stent placement, and one patient declined surgical therapy. The right pulmonary artery was treated in three patients, the superior vena cava was treated in one patient, and three pulmonary veins were treated in one patient. Outcome Measures.  Pertinent vessel and hemodynamics including immediate short-, and mid-term results were assessed. Procedural complications, midterm follow-up (up to 7 years), and overall survival were determined. Results.  Each intervention resulted in hemodynamic improvement with subsequent clinical improvement. Reintervention was required within 12 months in two of four percutaneously treated patients. One death occurred 4 days after cutting balloon angioplasty in a preexisting pulmonary vein stent. Conclusions.  Percutaneous therapy for vessel compression secondary to fibrosing mediastinitis is an option that is effective in improving short-term vascular patency. In-stent stenosis was a frequent complication in patients with fibrosing mediastinitis, particularly when pulmonary veins were involved. Short- and midterm success can be achieved, but progressive fibrosing mediastinitis remains a difficult clinical problem with repeat dilation of stents and/or additional stent placement necessary to maintain optimal stent patency and improvement in clinical symptomatology.
📖 Papers frequently viewed together
19881.55Medicine
4 Authors (James E. Loyd, ..., Des Prez Rm)
145 Citations
57 Citations
54 Citations
References30
Newest
#1David R. Holmes (Mayo Clinic)H-Index: 146
#2Kristi H. Monahan (Mayo Clinic)H-Index: 14
Last. Douglas L. Packer (Mayo Clinic)H-Index: 59
view all 3 authors...
Ablation procedures for atrial fibrillation are being performed with increasing frequency. One of the most serious complications is the development of pulmonary vein stenosis, which occurs in 1% to 3% of current series. The presentation of pulmonary vein stenosis varies widely. The majority of patients are symptomatic although specific referral bias patterns can affect this. Symptoms may include dyspnea or hemoptysis or may be consistent with bronchitis. These symptoms are affected by the number...
354 CitationsSource
#1Heath Giles (UT: University of Tennessee)H-Index: 2
#2Christopher J. Lesar (UT: University of Tennessee)H-Index: 4
Last. Stuart Myers (UT: University of Tennessee)H-Index: 1
view all 5 authors...
The current study was designed to investigate our hypotheses that balloon-expandable covered stents display acceptable function over longitudinal follow-up in patients with complex vascular pathology and provide a suitable alternative for the treatment of recurrent in-stent restenosis. All stents were Atrium iCast, which is a balloon-mounted, polytetrafluoroethylene-covered stent with a 6F/7F delivery system. A retrospective review was performed of 49 patients with 66 stented lesions. Data were ...
15 CitationsSource
#1Lourdes R. Prieto (Cleveland Clinic)H-Index: 1
#2Paul Schoenhagen (Cleveland Clinic)H-Index: 2
Last. Sarah E. Worley (Cleveland Clinic)H-Index: 1
view all 5 authors...
Introduction: Pulmonary vein stenosis (PVS) is a rare but significant complication of pulmonary vein isolation (PVI). Dilation and stent angioplasty have been described but not compared. Methods and Results: All percutaneous interventions for PVS complicating PVI between December 2000 and March 2007 were reviewed. Acute success, defined as post-intervention stenosis ≤30%, and long-term outcome of dilation versus stent angioplasty were compared. Freedom from restenosis was defined as freedom from...
129 CitationsSource
#1Nina Kaludercic (Johns Hopkins University)H-Index: 24
#2Merry L. Lindsey (University of Texas Health Science Center at San Antonio)H-Index: 52
Last. Nazareno Paolocci (University of Perugia)H-Index: 48
view all 5 authors...
Metalloproteinases (MMPs, also called matrixins) are extracellular proteolytic enzymes involved in the degradation of both matrix and nonmatrix proteins. Currently, 25 MMPs have been identified in humans, and the overexpression of one or more MMPs has been implicated in several pathologies, spanning from cancer to rheumathoid arthritis to cardiovascular disease. While research over the past 20 years has focused on understanding MMP biology and selectively inhibiting MMP activity, key issues that...
19 CitationsSource
#1Ruby Satpathy (Creighton University)H-Index: 7
#2Virginia Aguila (Creighton University)H-Index: 1
Last. Ijaz A. Khan (UMB: University of Maryland, Baltimore)H-Index: 37
view all 4 authors...
Abstract A rare case of fibrosing mediastinitis from histoplasmosis with extrinsic compression of the right pulmonary artery is reported. A 41-year-old patient presented with worsening symptoms of cough, fever, migratory arthralgia, chest pain, and progressive dyspnea. The pulmonary artery involvement was suspected by transthoracic echo and was confirmed by transesophageal echo, CT scan of chest, and right heart catheterization. Diagnosis of histoplasmosis was confirmed by biopsy and serological...
13 CitationsSource
#1Guilherme Bromberg-Marin (UCSD: University of California, San Diego)H-Index: 8
#2Sotirios Tsimikas (UCSD: University of California, San Diego)H-Index: 76
Last. Ehtisham Mahmud (UCSD: University of California, San Diego)H-Index: 30
view all 3 authors...
The increasing use of radiofrequency catheter ablation for the cure of atrial fibrillation has led to iatrogenic pulmonary vein stenosis as a new clinical entity. The optimal diagnostic modality and treatment for pulmonary vein stenosis and restenosis remain unclear. We report the successful treatment of pulmonary vein restenosis following percutaneous balloon angioplasty, and for the first time, following surgical bovine pericardial patch angioplasty, with endovascular stenting and adjuvant ora...
20 CitationsSource
#1Mark Turco (Adventist HealthCare)H-Index: 45
#2Maurice Buchbinder (Memorial Hospital of South Bend)H-Index: 22
Last. Mary E. RussellH-Index: 51
view all 10 authors...
Objectives: The purpose of this study was to evaluate the clinical and angiographic outcomes of the Symbiot ePTFE covered stent versus bare metal stents (BMS) for the treatment of saphenous vein graft (SVG) disease. Background: The Symbiot stent was developed to reduce periprocedural complications, by potentially preventing distal embolization, and to serve as a possible barrier to cell migration, thus reducing restenosis. Methods: Symbiot III is a prospective, randomized trial of 400 patients a...
90 CitationsSource
#1Amanda L. Cook (Duke University)H-Index: 4
#2Lourdes R. Prieto (Cleveland Clinic)H-Index: 20
Last. John F. Rhodes (Duke University)H-Index: 24
view all 4 authors...
After radiofrequency ablation for atrial fibrillation, patients may develop pulmonary vein stenoses requiring stent angioplasty. The treatment options for when such patients develop in-stent stenoses are poorly defined. The investigators retrospectively reviewed their initial experience with cutting balloon angioplasty for pulmonary vein in-stent stenosis. Ten patients with 21 previously stented pulmonary veins returned to the catheterization laboratory for in-stent stenoses. Angioplasty of indi...
23 CitationsSource
Objectives The purpose of this study was to assess the role of oral rapamycin in decreased restenosis after bare metal stent implantation. Background Small observational studies suggest that the administration of oral rapamycin reduces angiographic restenosis after bare metal stent implantation. Methods Between September 2003 and September 2004, 100 patients were randomized to either oral rapamycin (6-mg loading dose given 2.7 h before intervention followed by 3 mg/day for 14 days) plus diltiaze...
117 CitationsSource
#1Todd W. Rice (Vandy: Vanderbilt University)H-Index: 43
Last. Richard W. LightH-Index: 66
view all 3 authors...
Abstract:Malignancy is the most common cause of the superior vena cava (SVC) syndrome. With the increasing use of intravascular devices, the incidence of the SVC syndrome arising from benign etiologies is increasing. We reviewed the etiology and outcome of 78 patients with SVC syndrome over 5 years.
371 CitationsSource
Cited By16
Newest
ABSTRACT Pulmonary hypertension (PH) is a life-threatening disease with complex pathophysiology. The World Health Organization has classified PH in five groups according to etiology, the fifth of which corresponds to PH due to unknown or multiple mechanisms; including sarcoidosis-associated PH (SAPH). Although this system has been used to guide treatment recommendations according to each group, it does not provide much insight into the heterogeneous group 5. Furthermore, pulmonary vasodilators (...
2 CitationsSource
#1Adrian daSilva-deAbreu (UQ: University of Queensland)H-Index: 3
#1Adrian daSilva-deAbreu (UQ: University of Queensland)
Last. Stacy A. Mandras (UQ: University of Queensland)H-Index: 2
view all 6 authors...
Abstract Background Pulmonary angioplasty has been performed in patients with sarcoidosis-associated pulmonary hypertension (SAPH) but most evidence comes from case reports and small case series. Overall outcomes remain unclear. We conducted an individual participant data (IPD) meta-analysis of baseline, procedural, and outcome data of pulmonary angioplasty in patients with SAPH. Methods We performed searches and systematically reviewed references from PubMed, Embase, Cochrane, ClinicalTrials.go...
Source
#1John P. Welby (Mayo Clinic)H-Index: 5
#2Erin A. Fender (Mayo Clinic)H-Index: 9
Last. Erica M. Knavel-Koepsel (Mayo Clinic)
view all 6 authors...
Source
#1Himanshu Deshwal (NYU: New York University)H-Index: 3
#2Subha Ghosh (Cleveland Clinic)H-Index: 6
Last. Atul C. Mehta (Cleveland Clinic)H-Index: 55
view all 6 authors...
Fibrosing mediastinitis (FM) is a rare disorder of inflammation and fibrosis involving the mediastinum. The formation of fibroinflammatory mass in the mediastinum can lead to obstruction of mediast...
Source
#1Yichao DuanH-Index: 1
#2Xing Zhou (Lanzhou University)H-Index: 1
Last. Yunshan Cao (Lanzhou University)H-Index: 2
view all 9 authors...
Fibrosing mediastinitis (FM) is a very rare disease, often caused by histoplasmosis capsulatum, tuberculosis, sarcoidosis, autoimmunity and other diseases, such as IgG 4-related diseases. Fibrous structures in the mediastinum compress the pulmonary artery, pulmonary vein, superior vena cava, esophagus, trachea and cardiac vessels, leading to clinical symptoms. Drug therapeutic modality for pulmonary vein stenosis (PVS) caused by FM is palliative in essence and with limited efficacy, whereas surg...
Source
#1Hee Kang (Kosin University Gospel Hospital)
#2Min Jung Jung (Kosin University Gospel Hospital)
Abstract Fibrosing mediastinitis is an uncommon benign disorder in which a chronic inflammatory reaction results in diffuse fibrosis of the mediastinum, potentially compromising the airways, great vessels and other mediastinal structures. Herein we describe a progressive course of fibrosing mediastinitis in a 72-year-old man. Computed tomography images depicted a diffuse, infiltrative, soft tissue mass involving the esophagus and superior vena cava in the mediastinum. Magnetic resonance imaging ...
Source
#1Yidan LiH-Index: 6
#2Xiangli MengH-Index: 2
Last. Xiuzhang LuH-Index: 3
view all 5 authors...
INTRODUCTION: Fibrosingmediastinitis (FM) is caused by a proliferation of fibrous tissue in the mediastinum encasing the mediastinal viscera that results in compression of mediastinal bronchovascular structures. Pulmonary hypertension (PH) is a severe complication of FM caused by extrinsic compression of pulmonary blood vessels. CASE PRESENTATION: Here, we present the case of a 47-year-old man who presented with a 10-year history of progressive hemoptysis and a 2-year history of shortness of bre...
3 CitationsSource
Mediastinal fibrosis is a rare disease characterised by fibrous proliferation in the mediastinum. It can be idiopathic or secondary to several conditions such as infections and malignancies. Anecdotal reports have described idiopathic mediastinal fibrosis (IMF) in association with other fibro-inflammatory or autoimmune diseases. We report nine new IMF cases recently seen at our Fibro-Inflammatory Disease Clinic and reviewed the IMF cases reported in the English language literature throughout 200...
13 CitationsSource
#1Luis GorospeH-Index: 6
#1Luis Gorospe (Hospital Universitario de Canarias)H-Index: 1
Last. Eva Mañas-BaenaH-Index: 1
view all 7 authors...
Abstract Purpose The purpose of this study was to review the clinicoradiological features of idiopathic fibrosing mediastinitis (FM). Methods The records of six patients with idiopathic FM were retrospectively reviewed. Results The most common presenting symptom was cough. There were three localized forms and three diffuse forms. Definitive histological diagnosis was most commonly made with mediastinoscopy. Interestingly, three of our patients had disease manifestations of IgG4-related disease (...
13 CitationsSource
#1Shiva P. Ponamgi (Mayo Clinic)H-Index: 5
#2Christopher V. DeSimone (Mayo Clinic)H-Index: 18
Last. Douglas L. Packer (Mayo Clinic)H-Index: 59
view all 7 authors...
Introduction Fibrosing mediastinitis (FM) is a rare but fatal disease characterized by an excessive fibrotic reaction in the mediastinum, which can lead to life-threatening stenosis of the pulmonary veins (PV). Catheter-based intervention is currently the only viable option for therapy. However, the current literature on how best to manage these difficult cases, especially in regards to sequential interventions and their potential complications is very limited.
9 CitationsSource