Superior Vena Cava Syndrome in Emergency Medicine Treatment & Management
- Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Erik D Schraga, MD more...
Prehospital caregivers are aware of the superior vena cava syndrome (SVCS) diagnosis only on occasion.
The usual attention to airway, breathing, and circulation (ABCs) is required.
Superior vena cava syndrome only rarely manifests as a life-threatening entity; therefore, other causes for the symptomatology must be sought.
Emergency Department Care
Superior vena cava syndrome only rarely manifests as an acute emergency. Typically, the syndrome develops over weeks to months and is recognized when the typical signs of facial and upper extremity edema occur. Confusion related to associated cerebral edema or stridor from laryngeal edema and impending airway obstruction represent acute emergencies.
Attention to the ABCs is essential.
If patients are allowed to sit upright, they may experience some relief of the usual dyspnea.
Stabilize the airway, as needed, and consider steroids.
If cerebral/airway edema is present, consider diuretics; however, diuretics have not shown consistent benefit in the emergency department (ED).
Endovascular shunts are increasingly used, as are thrombolytics if a thrombotic cause is present.
After a tissue diagnosis, radiation and chemotherapy may be initiated.
Over the last 10 years, considerable experience with endovascular stenting of superior vena cava syndrome has been achieved.[4, 5] At many centers, endoprostheses have become the initial choice for palliative treatment of superior vena cava syndrome.
Emergent consultation with radiation therapy may be necessary, depending upon the acuteness of the presentation.
Because most causes of superior vena cava syndrome are related to lung cancer, a pulmonary or oncology consultation may be obtained.
Generally, considering the diagnosis in the ED is important. If the diagnosis is made de novo in the ED, only rarely is emergent consultation necessary. Exceptions include sudden airway compromise or acute superior vena cava thrombosis, which may occur from an indwelling catheter.
Chen JC, Bongard F, Klein SR. A contemporary perspective on superior vena cava syndrome. Am J Surg. 1990 Aug. 160(2):207-11. [Medline].
Thakker M, Keteepe-Arachi T, Abbas A, Barker G, Ruparelia N, Kingston GT, et al. A primary cardiac sarcoma presenting with superior vena cava obstruction. Am J Emerg Med. 2012 Jan. 30(1):264.e3-5. [Medline].
Lanciego C, Pangua C, Chacon JI, et al. Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. AJR Am J Roentgenol. 2009 Aug. 193(2):549-58. [Medline].
Sato Y, Inaba Y, Yamaura H, Takaki H, Arai Y. Malignant inferior vena cava syndrome and congestive hepatic failure treated by venous stent placement. J Vasc Interv Radiol. 2012 Oct. 23(10):1377-80. [Medline].
Dhaliwal RS, Das D, Luthra S, et al. Management of superior vena cava syndrome by internal jugular to femoral vein bypass. Ann Thorac Surg. 2006 Jul. 82(1):310-2. [Medline].
[Guideline] Kvale PA, Selecky PA, Prakash UB. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep. 132(3 Suppl):368S-403S. [Medline].
Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest. 1993 Apr. 103(4 Suppl):394S-397S. [Medline].
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. 1987 Apr. 13(4):531-9. [Medline].
Baker GL, Barnes HJ. Superior vena cava syndrome: etiology, diagnosis, and treatment. Am J Crit Care. 1992 Jul. 1(1):54-64. [Medline].
Bauset R. Pacemaker-induced superior vena cava syndrome: a case report and review of management strategy. Can J Cardiol. 2002 Nov. 18(11):1229-32. [Medline].
Courtheoux P, Alkofer B, Al Refai M, et al. Stent placement in superior vena cava syndrome. Ann Thorac Surg. 2003 Jan. 75(1):158-61. [Medline].
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. 2001 Sep. 177(3):585-93. [Medline].
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. 2008 Feb. 14(1):60-2. [Medline].
Link MS, Pietrzak MP. Aortic dissection presenting as superior vena cava syndrome. Am J Emerg Med. 1994 May. 12(3):326-8. [Medline].
Madan AK, Allmon JC, Harding M, et al. Dialysis access-induced superior vena cava syndrome. Am Surg. 2002 Oct. 68(10):904-6. [Medline].
Queen JR, Berlin J. Superior vena cava syndrome. J Emerg Med. 2001 Aug. 21(2):189-91. [Medline].
Wan JF, Bezjak A. Superior vena cava syndrome. Emerg Med Clin North Am. 2009 May. 27(2):243-55. [Medline].