Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

Abstract

Venous obstruction in the cancer population can result in substantial morbidity and, in extreme cases, mortality. While venous obstruction can be caused by both benign and malignant etiologies in this population, the management of malignant venous obstruction as a palliative measure can be somewhat nuanced with respect to nonprocedural and procedural management, both with respect to treatment of the underlying malignancy as well as treatment of venous hypertension, which may be associated with venous thrombosis. Symptom severity, primary malignancy, functional status, and prognosis are all fundamental to the patient workup and dictate both the timing and extent of endovascular intervention. The morbidity and mortality associated with malignant obstructions of central venous structures, specifically the superior vena cava and inferior vena cava, can be significantly improved with endovascular management in appropriately selected patients. Thus, the pertinent literature regarding the clinical presentation, workup, and endovascular management of malignant central venous obstruction syndromes, with directed attention to superior vena cava syndrome and inferior vena cava syndrome, will be reviewed in this article.

Narrow Escape: A Novel Approach to the Endovascular Treatment of Superior Vena Cava Syndrome Secondary to Pacemaker Leads with Excellent Long-term Outcomes

“…For years, syphilis and tuberculosis remained the main causes of SVC syndrome until antibiotics were discovered, which almost eliminated infectious etiologies. This led to malignancies being the most common reason for SVC obstruction [1]. Medicine continued to evolve and incidences of SVC syndrome have been falling dramatically throughout the 20th century.…”

“…Superior vena cava syndrome (SVCS) is a result of obstructed blood flow through the superior vena cava (SVC), causing characteristic symptoms. Historically, the most common etiology of SVCS is malignancy [1]. However, since the invention and more widespread use of permanent pacemakers (PPMs) and implantable cardioverter-defibrillators (ICDs), pacing and defibrillator leads are becoming a more common cause of SVCS.…”

Extended Patient Survival after Inferior Vena Cava Stent Placement for Obstruction Caused by Metastatic Colon Cancer

“…Compression of the inferior vena cava (IVC) by malignancy has been reported for a variety of histologies and is most commonly seen in advanced metastatic disease [1][2][3]. The symptoms and signs of inferior vena cava syndrome will depend on the severity of the vena cava compression and resulting pressure gradient.…”

Successful palliative peptide receptor radionuclide therapy for impending compression of vena cava due to unresectable liver metastasis of neuroendocrine tumor

“…Extravascular compression of inferior vena cava (IVC) by tumors is a rare but serious condition that can lead to increased intra-abdominal pressure, thrombosis, lower limb edema, liver and kidney damage and reduced cardiac venous return, causing hemodynamic disturbances and even life threatening hypovolemic shock (Mohammed et al, 2018[ 3 ]; Sonin et al, 1992[ 7 ]). Proper management of venous obstruction and prevention of potential thrombosis is a vital palliative care besides treating the underlying malignancy, leading to a decline in morbidity and mortality (Friedman et al, 2017[ 1 ]). Even though radical surgery of the primary tumor and the liver metastasis is the main curative strategy, masses are not always resectable due to extended size, vast local invasion to critical surrounding structures and patient's underlying conditions.…”