Superior Vena Cava Syndrome: Role of the Interventionalist

Abstract

Superior vena cava syndrome results from the obstruction of blood flow through the superior vena cava and is most often due to thoracic malignancy. However, benign etiologies are on the rise secondary to more frequent use of intravascular devices such as central venous catheters and pacemakers. Although rarely a medical emergency, the symptoms can be alarming, particularly to the patient. Traditionally, superior vena cava syndrome has been managed with radiotherapy and chemotherapy. But interventional endovascular techniques have made inroads that offer a safe, rapid, and durable response. In many cases, it may be the only reasonable treatment. Because of this, an approach to endovascular treatment of this condition must be in the armamentarium of the interventional radiologist. This review will provide the reader with an insight into the etiology, pathophysiology, and various management principles of superior vena cava syndrome. The focus will be on understanding the techniques used during various endovascular interventions, including angioplasty, stenting, and pharmacomechanical thrombolysis. Discussion will also be centred on possible complications and current evidence as well as controversies regarding these approaches.

Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond

“…When simple recanalization techniques fail, advanced techniques such as sharp recanalization with back-side of hydrophilic wires, needles, or radiofrequency wires have been successful, but should be used judiciously due to the potential risk of hemopericardium or hemothorax. 31 When using sharp recanalization, it is advised to have a target so that the three-dimensional anatomy on multiple fluoroscopic obliquities or fluoroscopic cone-beam CT is clear.…”

Iatrogenic occlusion of bilateral jugular veins, subclavian vein, and superior vena cava after repeated jugular cannulation associated with Arnold-Chiari malformation: Successful endovascular treatment

“…An attempt at endovascular treatment of intracranial hypertension resulting from stenosis or occlusion of the venous system was based on widely available publications regarding the efficacy of such treatment strategies. [1][2][3][4] Because no clear recommendations are available regarding covered and uncovered stent placement, we decided to insert an uncovered Zilver Vena, a dedicated venous stent, at the SVC recanalization site. Although Haddad et al 5 suggested higher effectiveness of covered stents, they also emphasized the need for further studies in this area.…”

Emergencies in Hematology and Oncology

“…Endovascular stenting of the SVC can promptly relieve symptoms of SVCS and is the treatment of choice in very symptomatic patients (Figure 9). 210,211 Radiation therapy is effective for many patients, but the relief of symptoms may be slow.…”