Endovascular treatment of superior vena cava syndrome

Abstract

Vena cava superior (VCS) is the largest vein in the body which collects returned blood from the head, upper extremities, and upper chest to the heart. Superior vena cava syndrome (SVCS) occurs when obstruction of VCS restrains the blood return to the right atrium. Nowadays malignant diseases are responsible for this syndrome in more than 97 % of the cases, mostly due to extrinsic tumor compression followed by compression by enlarged mediastinal lymph nodes. Approximately 5–10 % of patients with lung malignancies will develop SVCS. Also benign conditions like granulomatous mediastinal diseases, mediastinal fibrosis, struma, trauma, infection, aortitis, central venous lines, and pacemaker can cause SVCS. The management of SVCS depends on the histological type of the tumor as well as of the tumor stage. In principle there are two main treatment strategies, one with the primary aim of symptom relief (endovascular stent) and the other with the aim to treat the underlying cause of SVCV (radiotherapy or chemotherapy). Due to the terminal stadium of these patients, surgery is a very rare treatment option.