Upper extremity venography complements CT or MRI with defining level if obstruction
Emergent therapy indicated if:
CNS abnormalities such as stupor or seizures are present because may indicate increased intracranial pressure
If otherwise stable, treatment depends on the cause of SVC syndrome
XRT– primary treatment for SVC caused by non-small cell lung cancer and other metastatic tumors; however important to have tissue diagnosis before beginning XRT because XRT will obfuscate histology
Chemotherapy – effective when underlying tumor is chemosensitive, such as small cell lung cancer or lymphoma
Intravascular stents – effective palliative treatment. Often reserved for recurrent SVC syndrome (which is 10-30% of patients)
Surgery – immediate relief if SVC syndrome from a benign cause
Removal of foreign body and anticoagulation – if etiology is thrombus secondary to central venous catheter placement. Anticoagulation helps prevent embolization. If detected early enough, fibrinolytic therapy without catheter removal may be sufficient. Additionally low-dose coumadin (1-2 mg/day) reduces thrombus incidence
Steroids – decreases cerebral or pharyngeal edema
Diuretics– may provide temporary relief if respiratory symptoms present
Most (75-90%) improve symptomatically within one week of initiating treatment.
Mortality depends on underlying etiology of SVC syndrome
Chen JC, Bongard F, Klein SR. A contemporary perspective on superior vena cava syndrome. Am J Surg 1990; 160:207-211.
Cecil Textbook of Medicine. Last accessed via www.mdconsult.com July 15, 2002.
Harrison’s Online. www.harrisonsonline.com. Last accessed July 13, 2002.
Markman M. Diagnosis and management of superior vena cava syndrome. Clev Clin J Med 1999; 66:59-61.
Roberts JR, Bueno R, Sugarbaker DJ. Multimodality treatment of malignant superior vena caval syndrome. Chest 1999; 116:835-837.
Beth Israel Deaconess Medical Center Residents’ Report