eMedicine Specialties > Emergency Medicine > Cardiovascular

Superior Vena Cava Syndrome: Follow-up

Author: Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Contributor Information and Disclosures

Updated: Dec 31, 2008

Follow-up

Complications

  • Total superior vena cava (SVC) obstruction
    • Fortunately, this is rare.
    • Potential causes include indwelling catheters.
    • Thrombolysis must be considered.
  • Airway compromise is unusual but may result from extrinsic compression of the SVC or the trachea by the tumor mass.

Prognosis

  • Superior vena cava syndrome (SVCS) is associated with malignancy.
    • The prognosis for relief of SVCS symptoms is good with radiation therapy.
    • Symptoms usually decrease within 1 month of the onset of radiation therapy.
    • However, the ultimate prognosis is associated with the underlying malignancy itself.
  • The prognosis for SVCS not associated with malignancy is excellent because most of these causes are infectious and respond to appropriate antibiotic therapy.
  • Recently, management of SVCS by internal jugular to femoral vein bypass has been described.2 This may help improve symptoms of patients with malignancy.

Miscellaneous

Medicolegal Pitfalls

  • Potential medical/legal pitfalls include not considering the diagnosis in patients with known lung cancer. Their symptoms of increasing shortness of breath may be from SVCS. Symptoms may be relieved with radiation therapy.
  • In patients in whom the diagnosis of lung cancer is not known, patients' sensations of arms swelling, facial fullness, and related symptoms may tend to be discounted. An excellent opportunity may exist to positively affect a patient's prognosis if the diagnosis of SVCS is entertained and the underlying cause of cancer is considered.

Special Concerns

  • Special concerns include the need to be sensitive to patients' probable diagnosis of lung cancer.
    • In patients in whom the diagnosis has not been made, this represents a unique occasion for the clinician to approach the patient with care.
    • Special care must be taken to ensure that the explanation of the patient's symptoms is not rushed.
 


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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References

  1. Chen JC, Bongard F, Klein SR. A contemporary perspective on superior vena cava syndrome. Am J Surg. Aug 1990;160(2):207-11. [Medline].

  2. Dhaliwal RS, Das D, Luthra S, et al. Management of superior vena cava syndrome by internal jugular to femoral vein bypass. Ann Thorac Surg. Jul 2006;82(1):310-2. [Medline].

  3. Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest. Apr 1993;103(4 Suppl):394S-397S. [Medline].

  4. Armstrong BA, Perez CA, Simpson JR, Hederman MA. Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys. Apr 1987;13(4):531-9. [Medline].

  5. Baker GL, Barnes HJ. Superior vena cava syndrome: etiology, diagnosis, and treatment. Am J Crit Care. Jul 1992;1(1):54-64. [Medline].

  6. Bauset R. Pacemaker-induced superior vena cava syndrome: a case report and review of management strategy. Can J Cardiol. Nov 2002;18(11):1229-32. [Medline].

  7. Courtheoux P, Alkofer B, Al Refai M, et al. Stent placement in superior vena cava syndrome. Ann Thorac Surg. Jan 2003;75(1):158-61. [Medline].

  8. Lanciego C, Chacon JL, Julian A, et al. Stenting as first option for endovascular treatment of malignant superior vena cava syndrome. AJR Am J Roentgenol. Sep 2001;177(3):585-93. [Medline].

  9. Leggio L, Abenavoli L, Vonghia L, et al. Superior vena cava thrombosis treated by angioplasty and stenting in a cirrhotic patient with peritoneovenous shunt. Ann Thorac Cardiovasc Surg. Feb 2008;14(1):60-2. [Medline].

  10. Link MS, Pietrzak MP. Aortic dissection presenting as superior vena cava syndrome. Am J Emerg Med. May 1994;12(3):326-8. [Medline].

  11. Madan AK, Allmon JC, Harding M, et al. Dialysis access-induced superior vena cava syndrome. Am Surg. Oct 2002;68(10):904-6. [Medline].

  12. Queen JR, Berlin J. Superior vena cava syndrome. J Emerg Med. Aug 2001;21(2):189-91. [Medline].

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Further Reading

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Keywords

SVCS, superior vena cava syndrome, superior vena cava, SVC, bronchogenic carcinoma, endovascular stenting, endoprostheses, malignancy-associated SVCS, non-malignancy–associated SVCS, obstruction of superior vena cava, obstruction of SVC, compression of superior vena cava, compression of SVC, low intravascular pressure, interstitial edema, retrograde collateral flow, thrombus formation

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Contributor Information and Disclosures

Author

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard S Krause, MD, Senior Faculty, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Schering  Honoraria Speaking and teaching

 
 
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