eMedicine Specialties > Vascular Surgery > Medical Topics

Superior Vena Cava Syndrome: Follow-up

Author: Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Coauthor(s): LaMar O Mack, MD, Staff Physician, Department of Surgery, University of Tennessee Medical Center; Andre M Kallab, MD, Clinical Associate Professor of Oncology, Medical College of Georgia; Consulting Staff, Department of Oncology, Northeast Georgia Diagnostic Clinic
Contributor Information and Disclosures

Updated: Oct 28, 2009

Follow-up

Further Inpatient Care

Admit the patient to the hospital if symptoms of superior vena cava syndrome (SVCS) are moderate to severe and/or when a patient requires the administration of thrombolytic therapy or anticoagulation.

Further Outpatient Care

  • Instruct patients to use supportive measures, such as elevation of the head of the bed.
  • Carefully monitor the patient's symptoms and the adverse effects of the administered treatment. Patients should notify the physician immediately if any change in symptoms occurs.

Inpatient & Outpatient Medications

  • Oxygen supplementation may be provided if needed.
  • Antiemetics may be provided as needed to prevent nausea and vomiting.
  • For those patients started on steroids, taper steroids slowly, depending on the patient's condition.

Transfer

Transfer may be required for further diagnostic evaluation and surgical intervention.

Complications

Complications include laryngeal edema, cerebral edema, decreased cardiac output with hypotension, and pulmonary embolism (when an associated thrombus is present).

Prognosis

  • The survival of patients with superior vena cava syndrome (SVCS) depends mainly on the course of the underlying disease.
  • Untreated patients and those not responding to treatment survive approximately 30 days.

Miscellaneous

Medicolegal Pitfalls

  • Failure to establish the correct diagnosis and the underlying etiology
  • Failure to initiate immediate treatment
  • Failure to recognize a thrombus in the superior vena cava (SVC)
  • Failure to consult a medical oncologist and radiation therapist
  • Failure to expeditiously diagnose and appropriately manage heparin-related complications
    • In particular, one must monitor platelet count and be vigilant should a rapid decline in platelets occur. This suggests the possibility of platelet-induced thrombocytopenia syndrome (white clot syndrome). This rare syndrome may lead to extremity gangrene and life-threatening venous thromboembolism.
    • Management requires urgent discontinuation of heparin and urgent evaluation by a hematologist for appropriate pharmacotherapy.
    • Vascular surgical evaluation may also be indicated.
 


More on Superior Vena Cava Syndrome

Overview: Superior Vena Cava Syndrome
Differential Diagnoses & Workup: Superior Vena Cava Syndrome
Treatment & Medication: Superior Vena Cava Syndrome
Follow-up: Superior Vena Cava Syndrome
Multimedia: Superior Vena Cava Syndrome
References
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Further Reading

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Keywords

super vena cava syndrome, SVCS, superior vena cava, SVC syndrome, SVC obstruction, superior vena cava obstruction, syphilitic aneurysms, tuberculous mediastinitis, lung cancer, vena cava

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Contributor Information and Disclosures

Author

Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Todd A Nickloes, DO is a member of the following medical societies: American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

LaMar O Mack, MD, Staff Physician, Department of Surgery, University of Tennessee Medical Center
LaMar O Mack, MD is a member of the following medical societies: American Urological Association, National Medical Association, and Student National Medical Association
Disclosure: Nothing to disclose.

Andre M Kallab, MD, Clinical Associate Professor of Oncology, Medical College of Georgia; Consulting Staff, Department of Oncology, Northeast Georgia Diagnostic Clinic
Andre M Kallab, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

Richard M Stillman, MD, FACS, Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center
Richard M Stillman, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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