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Keimyung Medical Journal 2016;35(1):73-78.
Published online June 22, 2016.
Intractable in Stent Thrombosis in Malignant Superior Vena Cava Syndrome.
Sang Ho Lee, Chang Woo Shim, Ho Seok Chi, Hye In Lee, Do Il Choi, Heung Tae Kim, Hyun Beom Kim, In Joon Lee, Sun Young Kim
1Department of Internal Medicine, National Cancer Center, Goyang, Korea.
2Department of Oncology, National Cancer Center, Goyang, Korea.
3Department of Radiology, National Cancer Center, Goyang, Korea.
4Department of Oncology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
Endovascular treatment (EVT) including angioplasty and stenting is an effective treatment for superior vena cava (SVC) syndrome. Recurrence of SVC syndrome is mainly caused by tumor progression and occurs in around 20% after EVT, but sometimes venous thrombosis within stent accounts for recurrence of SVC syndrome. Anticoagulation after EVT is still a controversial issue. In our case, a 73-year-old man with SVC syndrome caused by mediastinal metastasis from non-small cell lung cancer underwent endovascular stent followed by anticoagulation with low molecular weight heparin (LMWH), but symptomatic progression due to in-stent thrombosis necessitated the second procedure after two weeks. A total of 4 sessions of endovascular stent and anticoagulation with LMWH, warfarin and rivaroxaban did not induce durable resolution of in-stent thrombosis. Our case suggests refractory in-stent thrombosis could develop despite of anticoagulation after endovascular stent for SVC syndrome.
Key Words: Anticoagulation, Endovascular treatment, Superior vena cava syndrome

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