Superior vena cava syndrome natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

If left untreated, patients with superior vena cava syndrome may progress to develop a complete blood flow obstruction and a decreased cardiac output with hypotension, leading to heart failure and death. Common complications of superior vena cava syndrome include airway obstruction, increased ICP, laryngeal edema, and cerebral edema. The prognosis will vary depending on the cause of the syndrome, and the amount of blockage that has already occurred. Prognosis is generally poor and the survival rate of patients with superior vena cava syndrome is approximately 10-20% at 6 months.^[1]

If left untreated, patients with superior vena cava syndrome may progress to develop a complete blood flow obstruction and a decreased cardiac output with hypotension, leading to heart failure and death. Common complications of superior vena cava syndrome include airway obstruction, increased ICP, laryngeal edema, and cerebral edema.

Complications that can develop as a result of superior vena cava syndrome are the following:^[1]

• Airway obstruction
• Laryngeal edema
• Cerebral edema
• Decreased cardiac output with hypotension
• Pulmonary embolism

• The prognosis of superior vena cava syndrome is good with treatment.
• Without treatment, superior vena cava syndrome will result in a rapid clinical evolution associated with a 10-20% mortality within 6 months.
• The presence of thoracic malignancies is associated with a particularly poor prognosis among patients with superior vena cava syndrome.^[2]
• Prognosis is also associated with the acute or gradual onset of the disease. Acute onset, relates with more severe symptoms because of absent collateral veins. Therefore there is no distention to accommodate the increased blood flow.
• Chronic onset is related with less severe symptoms because there is a presence of collateral veins that compensate increased flow.^[1]
• Patients with small cell bronchogenic carcinoma treated with chemotherapy and that simultaneously course with superior vena cava syndrome, the 2-year survival rate is 3%.
• Patients treated with radiation therapy, the relief of symptoms is greater, however the 2-year survival rate of 5% is almost the same for both groups.^[1]

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