Percutaneous Vascular Stent Implantation as Treatment for Central Vascular Obstruction Due to Fibrosing Mediastinitis

• Published in: Circulation (New York, N.Y.) Vol. 123; no. 13; pp. 1391 - 1399
• Main Authors: ALBERS, Erin L, PUGH, Meredith E, HILL, Kevin D, LI WANG, LOYD, James E, DOYLE, Thomas P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 05.04.2011
• Subjects: Adult; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Fibrosis; Humans; Male; Mediastinitis - pathology; Mediastinitis - surgery; Medical sciences; Middle Aged; Retrospective Studies; Stents; Treatment Outcome; Vascular Diseases - pathology; Vascular Diseases - surgery; pulmonary heart disease; Lung disease; Respiratory disease; Mediastinum disease; stents; Stenosis; Cardiovascular disease; Obstruction; Stent; Percutaneous route; Treatment; Heart disease; Fibrosing mediastinitis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.110.949180

Fibrosing Mediastinitis (FM) is a rare complication of infection with Histoplasma capsulatum that can lead to obstruction of pulmonary and systemic vasculature and large airways, often resulting in significant morbidity and mortality. Medical therapy is ineffective, and surgical intervention is often not feasible. Stent implantation offers a potential treatment for vascular obstruction due to FM, but this has not been well studied. We conducted a retrospective review of all patients undergoing cardiac catheterization for FM. Anatomic site of stenosis and hemodynamic information before and after intervention, as well as clinical presentation and follow-up data, were recorded. From 1996 to 2008, 58 patients underwent cardiac catheterization for FM, with intervention performed in 40 (69%). A total of 77 stents were used to relieve 59 lesions (pulmonary artery=26, pulmonary vein=21, and superior vena cava=12). Significant reduction in pressure gradients (P<0.001) and increase in vessel caliber (P<0.001) were seen at all locations. Symptomatic recurrent stenosis requiring further intervention occurred in 11 patients (28%). Median time to recurrence was 115 months. Thirty-two (87%) of 37 patients for whom follow-up was available reported symptomatic improvement after stent placement. related complications occurred in 14 patients (24%). Overall mortality was 19%, with the majority of deaths in patients with bilateral disease. Among patients with bilateral disease, intervention was associated with improved survival at 5 years. Percutaneous vascular stent implantation is an effective therapy for central vascular obstruction due to FM, providing significant relief of anatomic obstruction and sustained clinical improvement.