Interventions for superior vena cava syndrome

Endovascular Treatment for Upper Body Central Venous Obstruction

Endovascular treatment, such as catheter-directed thrombolysis, thrombectomy, balloon angioplasty, and metallic stent placement, is performed for symptomatic upper body central venous obstruction caused by both malignant and benign etiologies. In particular, metallic stent placement should be performed in emergent situations for malignant superior vena cava syndrome presenting with cerebral or laryngeal edema. In malignant cases, the obstruction is usually traversed via the femoral vein. When it fails, an additional trial via the brachial or internal jugular vein is performed, and if necessary, through-and-through access is established. In benign chronic obstructions that cannot be crossed by conventional techniques, sharp recanalization techniques are salvage options. The procedures are relatively safe; however, major complications such as acute pulmonary edema, cardiac tamponade, pulmonary embolism, and stent migration should be warned.

A Superior Squeeze: Superior Vena Cava Syndrome Secondary to Small Cell Lung Cancer

Superior vena cava (SVC) syndrome is an uncommon yet potentially fatal syndrome occurring after intrinsic or extrinsic compression to the SVC. While there are multiple emerging etiologies for this phenomenon, malignancy remains the most common. It is characterized by several symptoms including facial swelling, extremity swelling, shortness of breath, and headaches. We present the case of a 59-year-old female with a past medical history of cocaine abuse who was admitted for upper extremity swelling and facial edema. Imaging revealed a right suprahilar mass compressing a branch of the right pulmonary artery and SVC, in addition to bilateral segmental and subsegmental pulmonary emboli. She underwent an emergent biopsy and SVC stenting, with immunostaining revealing small cell lung cancer (SCLC). This case highlights a severe presentation of SVC syndrome caused by previously undetected SCLC.

Central Venous Catheter-Associated Superior Vena Cava Syndrome

Superior vena cava syndrome (SVCS) is caused by any obstruction to the superior vena cava (SVC); the most common causes are malignancy and extrinsic compression. The use of medical devices, such as central venous catheters, poses an important risk factor, as they cause changes in the blood flow and in the vessel wall. This report describes a case of a 70-year-old male with an implantable central venous port, due to previous neoplastic disease, as the cause of the SVCS. Authors advise that the placement of medical devices ought to be carefully accessed and constantly revised to be removed when no longer needed to prevent avoidable complications.