Non-malignant superior vena cava syndrome: Diagnostic and therapeutic modalities


AKÇALI Y. F.

8th International Congress of Update in Cardiology and Cardiovascular Surgery, Turkey, 1 - 04 December 2008, vol.31, pp.46

  • Publication Type: Conference Paper / Summary Text
  • Volume: 31
  • Country: Turkey
  • Page Numbers: pp.46

Abstract

Background. Superior vena cava syndrome (SVCS), which results from the obstruction of the blood flow in the superior vena cava (SVC), is well known since the last quarter-millenium. Obstruction of SVC is caused by tumor invasion (lung cancer), extrinsic pressure, in situ venous thrombosis from pacemaker/defibrilator leads or central venous access catheters, Behçet disease, or impedance of venous return from intraatrial or intraluminal pathology. We presented our experience with treatment of SVCS not caused by direct tumor infiltration, i.e., nonmalignant SVCS. Patients and method. In our department, 11 patients, three of them was a female, with nonmalignant SVCS were followed-up and treated between 2006-2008. The patients’ median age was 45 years (range, 18 to 65 years). Behçet disease (BD) was the most frequent cause of nonmalignant SVCS (72.7%). The patients with BD were either following with diagnosis of BD or had been admitted initially to hospital with symptoms and signs of venous disease. The signs of symptoms of SVCS, which is a clinical diagnosis, permitted easy recognition (Figures 1A, 2A and 3A). Diagnosis of SVCS was verified by duplex ultrasound, MRA, CTA and/or contrast venography (Figures 1B and 2B). Conservative measures such as head elevation, rest, judicious administration of fluid, limiting dietary sodium intake, and supplemental oxygen were important primary maneuvers in all patients. Results. According to angiographic classification, Type III was seen more frequently (45.4%).Two cases with BD were treated by jugulo-atrial bypass grafting (Figures 1C and 2C). One patient’s venous revascularization was achieved by thromboendvenectomy of occluded veins and patchplasty with a pericardial patch (Figure 3 B and C). Conclusion. Surgical management with long-term results is an effective therapeutic modality. Although spiral saphenous vein graft remains the conduit of choice for surgical reconstruction, its obtaining is always not possible, and therefore expanded externally supported polytetrafluoroethylene is a good alternative. Although endovascular treatment for SVC obstructions of other nonmalignant etiology is effective in the short term, with frequent need for repeat interventions, it is not always possible in BD. We should also keep in mind that thromboendvenectomy and patchplasty is important alternative.