Superior Vena Cava Syndrome. From the Bronchus to the Vessel

C Witt,A C Borges,B Schmidt,P Romaniuk,G Baumann,W Doerffel

doi:10.1155/dte.4.83

Abstract

This paper addresses the diagnosis and management of superior vena cava syndrome (SVCS) due to malignant intrathoracic tumours. Diagnosis of SVCS is usually established by bedside examination. Chest X-ray and computed tomography may be helpful, but the cavography remains the “gold-standard”. Other imaging techniques (MRI, nuclear flow studies) are more of scientific interest. Bronchoscopy helps to evaluate the risk of pulmonary complications and endoscopic procedures often lead to histological findings. In the treatment of malignant SVCS surgery, radiotherapy, and chemotherapy have been successfully used. The placement of a vascular stent might be an additional or alternative possibility. There are no conclusive indication criteria and no conclusive regimen concerning post-stenting anticoagulation. From all reported results and published papers we draw the conclusion that the immediate effects of stent implantation and the long-term results of tumour-specific therapy are complementary to one another. The stent dilates the local venous stenosis while tumour-specific therapy has a general effect on the vascular and respiratory situation in a multi-therapy concept.

Highlights

TABLE Findings in the first 13 patients with superior vena cava syndrome (SVCS) treated with a venous stent. (No =number, small-cell lung cancer (SCLC)=small cell lung carcinoma, NSCLC=non-small cell lung carcinoma, SVC=superior vena cava, jugular=right jugular vein, brachioceph= brachiocephalic trunc)
Prior to stent placement thrombolysis has been performed in some patients with SVCS or subclavian thrombus using Streptokinase, Urokinase or recombinant tissue-type plasminogen activator [6,23,45,46,47]
The procedure of the implantation is performed via percutaneous femoral [5,7,8,18,23,48,49,50,51], antecubital 18,51 or jugular [7,22] vein approach, TABLE II Published studies, venous stent implantation in malignant superior vena cava syndrome. (w-Wallstent, g- Gianturco-Z-stent, rec- recurrence in n cases, d days, no information)

Summary

SYMPTOMS AND CAUSES OF SUPERIOR VENA CAVA SYNDROME

The superior vena cava (SVC) is the the major drainage system for blood from the upper part of the body including the head and the arms. The superior vena cava syndrome (SVCS) is characterized by venous congestion of the upper extremities, head, and neck in most of the patients [1] (Fig. 1). While these symptoms often appear slowly and are not noticed by the patient severe dyspnoea often makes the patient look for medical advice. MRI seems valuable in diagnosing intra-thoracic venous obstruction with a sensitivity of 94% and specificity of 100%, but seems less suitable for evaluating patency after endoprothesis placement because of stent-induced artefacts [28] In this case stenting of the airway and SVC may be indicated (Figs. 4(a), (b))

TREATMENT OF SVCS

SVC jugular brachioceph jugular brachioceph

VENA CAVA STENTING

Furui et aL

DISCUSSION

Venoplasty Stent