Superior Vena Cava Superior vena cava obstruction In most cases of superior vena cava syndrome, treatment aims to reduce symptoms and shrink any tumor causing the obstruction. • Ganeshan A, Hon LQ, Warakaulle DR, et al. However, this is now reserved for cases in which recanalization through endovascular repair is either not possible or has previously failed. To the Editor: In the August 16 issue of the Journal, Drs. The types of cancer that can lead to this condition include: Breast cancer. Patients: All patients with superior vena cava (SVC) obstruction referred for evaluation and treatment. Despite the rise of benign cases of SVCS, as a thrombotic complication of intravascular devices, it is most commonly seen secondary to … It is most often caused by cancer or a tumor in the mediastinum (the area of the chest under the breastbone and between the lungs). Superior vena cava syndrome is a potentially life-threatening medical condition; however, superior vena cava syndrome is not fatal in the majority of cases. Superior vena cava (SVC) syndrome is a collection of clinical signs and symptoms resulting from either partial or complete obstruction of blood flow through the SVC. However, the use of intravenous stents is becoming increasingly common (1). Superior vena cava obstruction (SVCO) is characterized by facial and upper limb swelling, headache, and shortness of breath and usually is caused by advanced mediastinal malignancy. The treatment may also include the use of radiation, along with chemotherapy and surgery, as a means of shrinking the tumors. The SVC functions as the primary venous drainage system from the head, neck, upper extremities, and upper thorax; the … 7). Patients with SVC syndrome usually have advanced disease and fewer than 10% survive more than 30 months after treatment (1). Treatment • Radiation therapy with or without chemotherapy is the preferred treatment in most malignant causes of SVC obstruction, particularly in treatment-sensitive cancers such as small cell lung cancer. Treating SVCO Superior vena cava obstruction (SVCO) is most commonly due to malignant or thrombotic causes. 1999. Superior vena cava (SVC) syndrome (SVCS) is obstruction of blood flow through the SVC. Removal of the central line or replacement of the pacemaker wire, if possible, should be considered. Introduction. Water pills or steroids (anti-inflammatory drugs) may be used as short-term relief measures from swelling. Stents. Brief Summary: The treatment objective for patients with SVC syndrome secondary to both malignant and benign etiologies is to reduce the elevated central venous pressures.1 However, the strategies are contingent upon the underlying disease process. Superior Vena Cava (SVC) Endovascular Reconstruction with Implanted Central Venous Catheter Repositioning for Treatment of Malignant SVC Obstruction. Gwon DI, Ko GY, Kim JH, et al. The obstruction of blood flow through the superior vena cava (SVC) into the right atrium may present as a severe clinical syndrome. Superior vena caval stenting is an image guided technique that restores the venous return in patients with superior vena cava obstruction. In mild cases, watchful waiting may be the only treatment recommended. Collateral venous flow usually develops rapidly around SVC obstruction. Response - Treatment options are Dexamethasone, stent, radiotherapy and urgent chemotherapy depending on cancer type and grade of SVCO TIP : If treating with Dexamethasone Check diabetes risk and regular glucose monitoring SVC syndrome was first described by William Hunter in 1757. The patients remain free of SVC obstruction symptoms 24 +/- 19 months after treatment. • 95% of SVCO is caused by malignancy (80% due to lung cancer). Endovascular interventions are available today to manage it in many cases. Conventionally, obstruction of the superior vena cava has been regarded as an oncological emergency requiring immediate treatment. The results of radiotherapy are better for lymphoma than bronchogenic carcinoma. Patient information - Superior vena cava obstruction (SVCO) - External Beam Radiation Therapy (EBRT) ... Short term side effects: May occur during treatment or within a few weeks of finishing radiation therapy and usually settle within 4 … We present a technique for evaluation of SVC syndrome using small-gauge butterfly needles and intravenous digital subtraction angiography, and we report our results in ten patients. The symptoms resulting from compression or obstruction of the SVC system at any level, from the left and right brachiocephalic veins to the right atrium. 2007;49(9):1003–9. Malignancy. Ensure that the patient has no life-threatening symptoms (e.g. Of the 11 patients, seven patients had … Superior vena cava syndrome (SVCS) happens when the superior vena cava is partially blocked or compressed. This book describes Superior Vena Cava Syndrome, Diagnosis and Treatment and Related Diseases SVC syndrome is a constriction or obstruction of the superior vena cava (SVC), which is the second largest vein in the human body. Steroids may be helpful despite the absence of evidence to support their use. Superior vena caval stenting for SVC obstruction: current status. Cancer is the primary cause of SVCS. Radiology. Lymphoma. The syndrome may be caused by benign causes but most of the cases are caused by lung or mediastinal malignant tumors. Superior vena cava (SVC) obstruction is a relatively rare condition. Superior vena cava obstruction results from any limitation of blood flow through the superior vena cava. Several reports have shown thrombolytic therapy with intravenous streptokinase or urokinase to be effective in the treatment of this condition. Placement of a stent (tube placed inside a blood vessel) to open up the SVC may be performed. Superior vena cava stenting is able to provide rapid relief of symptoms safely in the vast majority of patients. Other types of cancer that can lead to this condition include: SVC obstruction can also be caused by noncancerous conditions that cause scarring. 2013;266:979-987. Various modalities of treatment have been advocated for the management of SVC obstruction. 11. Superior vena cava (SVC) syndrome is a clinical diagnosis that is caused by compromised venous blood return from the head and upper extremities due to compression and obstruction of the SVC. I disagree with the authors. Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. The role of stenting in vena caval obstruction of benign aetiology is less well defined. This lets the … SVC Venograms & Treatment. Thony F, Moro D, Witmeyer P, Angiolini S, Brambilla C, Coulomb M, et al. Thrombolytic therapy with streptokinase, urokinase, or anistreplase has been shown to be effective treatment of thrombotic occlusion of the SVC. Superior vena cava obstruction syndrome: recommendations for management. Successful fibrinolytic therapy for superior vena cava thrombosis secondary to long-term total parenteral nutrition. Thrombolysis and anticoagulation may be indicated for thrombosis. Stenting of SVC has become … if obstruction distal to azygos insertion on the SVC, compensation occurs. Superior vena cava obstruction. Obstruction can be caused by external compression and or internal blockage by a thrombus. Weight and age are not risk factors for early re-intervention. This obstruction is most commonly a result of thrombus formation or tumor infiltration of the vessel wall. CrossRef Google Scholar Tzifa A, et al. Superior vena cava (SVC) syndrome is a complication that occurs when malignancies, particularly in advanced lung cancer and mediastinal tumors, cause obstruction to the SVC (1,2).It has been reported that SVC syndrome occurs in approximately 4% of lung cancer patients at diagnosis and may develop during the disease course.Until recently, radiation … 9 (5):965-71. Endovascular treatment for superior vena cava occlusion or obstruction in a pediatric and young adult population: a 22-year experience. 10. Venous bypass grafts or pericardial grafts are major operations. Superior vena cava (SVC) syndrome is a set of effects that occur when blood flow through the superior vena cava (the large blood vessel that returns blood from the upper body back to the heart) is partially or fully blocked. The superior vena cava is a major vein in your upper body. Learning objectives To learn about pathophysiology and clinical presentation of malignant SVC obstruction To learn about techniques of SVC stenting SVC syndrome is caused by obstruction of blood flow through the SVC. Patients selected for surgery should have the Category-IV venographic signs, i.e, total vena caval obstruction. SVC obstruction is a rare condition. Discontinue promptly if no benefit and reduce gradually in responders. Yes, I finished chemo a few years ago. The presentation can be either subacute/chronic or acute ( in rapidly growing tumours). The may be due to obstruction external compression (benign or malignant), Fibrosis or thrombosis. If no contraindication to corticosteroids, commence dexamethasone oral (IV if swallow problems) 8 mg twice daily (morning and lunchtime) with gastroprotection if appropriate (e.g. Superior vena cava obstruction (SVCO) is generally caused by extrinsic compression by metastases in upper mediastinal lymph nodes. The superior vena cava transports blood from the upper half of the body to the heart. Int J Surg Case Rep. 2015;13:84-87. Radiation therapy palliates SVC obstruction in 70% of patients with lung carcinoma and in more than 95% of those with lymphoma. Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. Diagnostic evaluation and emergency therapy are always necessary to assess … This can be due to extrinsic compression of the vessel (tumor), intrinsic obstruction (thrombus), or a … • Chemotherapy would be the initial treatment of choice if a definitive diagnosis of lymphoma has been made. 14. This syndrome is usually an acquired condition and the different causes are: Malignant: it is the main cause. The sign & symptoms of superior vena cava obstruction are caused by obstruction of venous return from head & neck, upper thorax and upper limbs via superior vena cava. Introduction. Surgical Treatment Surgical bypass is an additional alternative to relieve SVCS. Other types of cancer that can lead to this condition include: SVC obstruction can also be caused by noncancerous conditions that cause scarring. Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. Superior vena cava syndrome with malignant causes. A review of 11 patients stented for vena caval obstruction and a review of recent series in the literature is presented. syndrome of superior vena cava obstruction secondary to lung malignancy. Superior vena cava (SVC) syndrome: definition. The diagnosis can be made clinically, but imaging studies are … Placement of a stent (tube placed inside a blood vessel) to open up the SVC may be performed. [13] The presentation can be either subacute/chronic or acute ( in rapidly growing tumours). Eur Radiol. SVC obstruction prevalence after device implantation is low. Greco and Oldham proposed chemotherapy as the primary treatment for superior vena cava obstruction and bronchial obstruction due to small-cell carcinoma of the lung. SVC syndrome is caused by obstruction of blood flow through the SVC. What Is Svc Obstruction? CAUSES OF SVC OBSTRUCTION . Treatment Of SVCO Depending on the underlying condition, multiple treatment options are available for superior vena cava obstruction. The primary treatment options include Medical Care Radiation Chemotherapy Thrombolytic therapy Anticoagulation Stents and balloon angioplasty and Surgery. Surgery to bypass the obstruction is rarely performed. Treatment is dependent on the cause of the obstruction, the severity of the symptoms and the patient’s prognosis. Other treatment options may include radiation or chemotherapy to shrink the tumor, or surgery to remove the tumors. Stephanie Volpi Cardio-Thoracic and Vascular Unit, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Superior Vena Cava Syndrome (SVCS), by definition, describes the clinical presentation of obstruction to blood flow in Superior Vena Cava (SVC). Open surgical repair through bypass grafting with spiral saphenous vein, femoral vein, polytetrafluoroethylene (PTFE) graft, or Dacron graft have traditionally been considered to overcome SVC obstruction. Surgical Treatment Surgical bypass is an additional alternative to relieve SVCS. Venous thrombosis can cause an acute onset of symptoms. Surgery is typically now indicated only for direct tumoral involvement. Conclusions SVC stent implantation is more effective than angioplasty in relief of SVC obstruction. The management of patients with life-threatening SVC syndrome is evolving from radiation therapy to endovascular therapy as the first-line treatment. Bellefqih S, Khalil J, Mezouri I, et al. Consider † dexamethasone 16mg orally or parenterally immediately and the subsequent day † dexamethasone 8mg twice daily orally (second dose before 2pm if possible). Treatment of superior vena cava syndrome will depend on the cause of the compression. Conventional palliative treatment relies on radiotherapy, chemotherapy, and sometimes surgery. Malignant superior vena cava syndrome: a comparative cohort study of treatment with covered stents versus uncovered stents. The traditional treatments of surgery, radiotherapy or chemotherapy either have a high morbidity and mortality rate, or a lag period of a few weeks prior to response. It may be primary neoplasm (fig.1-6) or mediastinal nodal metastases (fig. In the management of superior vena cava syndrome (SVCS), the goals are to relieve symptoms and to attempt cure of the primary malignant process. Thrombotic occlusion of the superior vena cava is an uncommon but serious complication of chronic indwelling venous catheters. Superior vena cava syndrome (SVCS) refers to a partial blockage of the vein (vena cava) that carries blood from the head, neck, chest and arms to the heart. The drawing below shows where the superior vena cava is in your body. Endovascular stenting in malignant obstruction of superior vena cava. Main outcome measures: Patients who had clinical features related to SVC obstruction and full investigation including tissue diagnosis were collated. The SVC obstruction causes it to narrow or blockage. SVC obstruction is a rare condition. It is most often caused by cancer or a tumor in the mediastinum (the area of the chest under the breastbone and between the lungs). Other types of cancer that can lead to this condition include: Breast cancer. Only a small percentage of patients with rapid-onset obstruction of the superior vena cava (SVC) are at risk for life-threatening complications. This can be due to extrinsic compression of the vessel (tumor), intrinsic obstruction (thrombus), or a … Cancer is the most common underlying cause of superior vena cava obstruction. SVC stenting is safe and effective in patients who develop the SVC obstruction after cardiac pacemaker insertion. Endovascular treatment of superior vena cava obstruction in patients with malignancies. This condition, also known as SVC syndrome, is an uncommon occurrence that affects approximately 15,000 patients each year in the United States. Patients with SVCO Percutaneous stenting of the SVC is a minimally invasive procedure which allows rapid alleviation of symptoms without interfering with tumour treatment. SVC is the principle venous drainage to head, neck and upper extremities. Surgery to bypass the obstruction is rarely performed. 9,13,14 Non-small-cell lung cancer (NSCLC) is the most common malignant cause of SVCS, accounting for 50% of all cases, followed by small-cell lung cancer (SCLC) … Venous hypertension produces head, neck and upper … Superior vena cava syndrome encompasses a collection of signs and symptoms resulting from … Superior vena cava (SVC) syndrome is a complication that occurs when malignancies, particularly in advanced lung cancer and mediastinal tumors, cause obstruction to the SVC (1,2).It has been reported that SVC syndrome occurs in approximately 4% of lung cancer patients at diagnosis and may develop during the disease course.Until recently, radiation … treatment As per our institute’s policy, patients with SVCO are initiated on symptomatic treatment immediately after clinical assessment at the time of admission and planned for histopathological evaluation within 24-48 hrs. While the diagnosis of superior vena cava obstruction (SVCO) is often made on clinical grounds in patients with a history of thoracic malignancy, a ches t X-ray and CT scan may confirm the diagnosis and inform treatment. The syndrome may be caused by benign causes but most of the cases are caused by lung or mediastinal malignant tumors. SVC obstruction is a rare condition. Using the superior vena cava, blood flows from the upper half of your body to the heart chamber. It also can occur from noncancer causes. Chapter 63 Superior Vena Cava Obstruction Surgical Treatment Peter Gloviczki, Manju Kalra Symptoms of venous congestion of the head and neck secondary to occlusion of the superior vena cava (SVC) or innominate veins develop in about 15,000 patients each year in the United States.1 SVC syndrome is caused by malignant tumors of the lung and… Patients selected for surgery should have the Category-IV venographic signs, i.e, total vena caval obstruction. Several reports have shown thrombolytic therapy with intravenous streptokinase or urokinase to be effective in the treatment of this condition.
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