Superior vena cava syndrome surgery

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

Elective stent placement and surgical bypass is recommended for all patients who develop superior vena cava syndrome.

There have been numerous small studies that used an intravascular expandable stent to reopen the occluded SVC; however, no prospectively designed comparative studies have been published. The reported response rates have been about 90% or greater. There is no agreement on the need for anticoagulant therapy after stent placement. In one series that used anticoagulant therapy for patients as part of the treatment protocol, there were reports of re-occlusion after this therapy was stopped. However, in another study, 17 cancer patients who were treated with stents and who did not have anticoagulant therapy had no occlusions.

Surgical bypass is more appropriate for patients with a benign obstruction than with a malignant obstruction, although surgical bypass has also been used for patients with malignant obstructions.

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