This paper is only available as a PDF. To read, Please Download here.
The superior vena cava (SVC) syndrome is usually associated with advanced malignancy
and has a dismal prognosis. In order to analyze the impact of newer diagnostic and
therapeutic modalities, we retrospectively examined the last 45 consecutive cases
of SVC syndrome treated over a 12-year period. The underlying causes were advanced
lung cancer (57%), mediastinal tumors (20%), and metastatic solid malignancy (5%).
Forty-two patients (93%) were treated with external beam radiotherapy and/or chemotherapy
with a mean patient survival of 3 months; 11 of 42 patients (26%) were treated without
histologic diagnosis. Symptoms of SVC obstruction resolved in 80% of patients who
underwent radiotherapy, with a mean interval of 4 weeks. The most common cause of
death was respiratory arrest. Of the three patients with benign disease, two underwent
caval reconstruction with greater than 3-year patency and relief of symptoms.
We conclude that (1) SVC syndrome portends a grim prognosis when associated with malignancy
but usually responds to radiation or chemotherapy; (2) CT scan is the best available
method to document the extent and location of involvement; and (3) patients with benign
disease should be evaluated for caval reconstruction, which may produce rewarding
long-term results.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Disease of great vessels.in: Schwartz SI Shires GT Spencer FC Principles of surgery. 5th ed. McGraw-Hill, San Francisco1989
- The history of an aneursym of the aorta with some remarks on aneurysms in general.Med Observ Inq. 1757; 1: 323-357
- Obstruction of the superior vena cava: a review of the literature and report of two personal cases.Ann Intern Med. 1949; 30: 925-960
- Superior vena cava syndrome: experience in a teaching hospital.South Med J. 1987; 80: 1243-1245
- Etiologic consideration in superior vena cava syndrome.Mayo Clin Proc. 1981; 36: 407-413
- Superior vena cava syndrome.J Vasc Dis. 1967; 4: 59-65
- Superior vena caval obstruction. Is it a medical emergency?.Am J Med. 1981; 70: 1169-1174
- Surgical treatment of idiopathic mediastinal fibrosis: report of five cases.Thorax. 1986; 41: 210-214
- Relief of superior vena caval syndrome with autologous femoral vein used as a bypass graft.J Thorac Cardiovasc Surg. 1985; 89: 750-752
- Obstruction of the superior vena cava and trachea from benign goiters.Indiana Med. 1986; 79: 1047-1049
- Superior vena caval obstruction: an analysis of seventy-six cases, with comments on the safety of venography.Angiology. 1985; 36: 354-357
- Superior vena cava syndrome caused by benign intrathoracic goiter.Acta Clin Belg. 1983; 38: 329-332
- Idiopathic fibrosis of mediastinum: a discussion of three cases and review of the literature.J Clin Pathol. 1978; 31: 78-88
- The superior mediastinal syndrome in children with cancer.AJR. 1965; 93: 537-544
- Evaluating the superior vena cava syndrome.JAMA. 1981; 245: 951-953
- Obstruction of the superior vena cava.Surgery. 1979; 85: 14-24
- Superior vena cava syndrome. Clinical management.JAMA. 1975; 231: 58-61
- Superior vena cava obstruction.Ann Thorac Surg. 1975; 20: 344-359
- The current status of vena caval replacement.Surgery. 1974; 76: 209-233
- Malignant obstruction of the superior vena cava and its palliation.J Thorac Cardiovasc Surg. 1977; 74: 244-248
- Bypass of superior vena cava.J Thorac Cardiovasc Surg. 1982; 83: 326-338
- Benign superior vena cava syndrome.Chest. 1975; 68: 32-35
Article info
Footnotes
2Presented at the 18th Annual Meeting of the Society for Clinical Vascular Surgery, Palm Desert, California, March 7–11, 1990.
Identification
Copyright
© 1990 Reed Publishing USA. Published by Elsevier Inc.
