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Superior Vena Cava Syndrome Medication

  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Sep 28, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Corticosteroids

Class Summary

These agents reduce swelling in patients with cerebral or laryngeal edema.

Dexamethasone (Decadron, Dexasone)

 

Important therapeutic agent in a number of malignant diseases. Exerts biologic action predominately by binding to glucocorticoid receptor. For symptomatic management in tumor-associated edema.

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Thrombolytics

Class Summary

The potential benefits of thrombolytics for the treatment of pulmonary embolism include fast dissolution of physiologically compromising pulmonary emboli, quickened recovery, prevention of recurrent thrombus formation, and rapid restoration of hemodynamic disturbances. For deep vein thrombosis, lysis of the thrombus can prevent pulmonary embolism and permanent pathologic changes, such as venous valvular dysfunction and postphlebitic syndrome.

Urokinase (Abbokinase)

 

Converts plasminogen to plasmin, which degrades fibrin clots, fibrinogen, and other plasma proteins.

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Anticoagulants

Class Summary

In superior vena cava syndrome (SVCS), these agents are used mainly to prevent pulmonary embolism from superior vena cava (SVC) thrombus.

Heparin

 

Inhibits thrombosis by inactivating activated factor X and inhibiting conversion of prothrombin to thrombin.

Warfarin (Coumadin)

 

Inhibits synthesis of vitamin K–dependent coagulation factors (factors II, VII, IX, X).

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Contributor Information and Disclosures
Author

Todd A Nickloes, DO, FACOS Associate Professor, Department of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center-Knoxville

Todd A Nickloes, DO, FACOS is a member of the following medical societies: American Medical Association, American Osteopathic Association, Association for Academic Surgery, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, Southern Medical Association, Eastern Association for the Surgery of Trauma, American College of Osteopathic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Society of Hematology

Disclosure: Nothing to disclose.

LaMar O Mack, MD Resident 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, Student National Medical Association

Disclosure: Nothing to disclose.

Allan Bernard Dunlap, MD Fellow in Trauma/Surgical Critical Care, University of Tennessee Health Science Center College of Medicine

Allan Bernard Dunlap, MD is a member of the following medical societies: American College of Surgeons, Society for Vascular Surgery

Disclosure: Nothing to disclose.

Chandler Long, MD Resident Physician, Department of Surgery, University of Tennessee Medical Center-Knoxville

Disclosure: Nothing to disclose.

Sagar S Gandhi, MD Resident Physician, Department of Surgery, University of Tennessee Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

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Superior vena cava syndrome (case 1). Patient was 35-year-old man with 3-year history of progressive upper-extremity and fascial swelling. Patient had undergone treatment for histoplasmosis in the past. CT shows narrowed superior vena cava with adjacent calcified lymph nodes and posterior soft-tissue thickening.
Superior vena cava syndrome (case 1, continued). Sonogram shows markedly damped venous waveform with complete loss of normal venous pulsatility and minimal respiratory variation.
Superior vena cava syndrome (case 1, continued). Venogram shows almost complete occlusion of superior vena cava with dramatic collateral drainage through left superior intercostal vein.
Superior vena cava syndrome (case 1, continued). Palmaz P308 stent mounted on 12-mm balloon was deployed in superior vena cava after it was predilated to 8 mm. Stent was subsequently dilated to 14 mm.
Superior vena cava syndrome (case 1, continued). Venogram obtained after stenting shows widely patent superior vena cava with no collateral drainage. Pressure measurements after stenting showed 1- to 2-mm residual gradient.
Superior vena cava syndrome (case 1, continued). Sonogram obtained 1 year after stenting shows near-normal venous pulsatility and respiratory phasicity. Patient experienced complete resolution of symptoms.
 
 
 
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