Superior vena cava syndrome medical therapy

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Superior Vena Cava Syndrome Microchapters


Patient Information


Historical Perspective



Differentiating Superior Vena Cava Syndrome from Other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis



History and Symptoms

Physical Examination

Laboratory Findings

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Medical Therapy

Radiation Therapy


Primary Prevention

Cost-Effectiveness of Therapy

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Case #1

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


Superior vena cava syndrome is a medical emergency and requires prompt treatment. The treatment of superior vena cava depends on the etiology of the obstruction, the severity of the symptoms, the prognosis of the patient, patient preferences, and goals for therapy.

Medical Therapy

Patients with sufficient collateral blood flow and minimal symptoms may not need treatment. If the lesion is above the azygous vein or if the onset of superior vena cava occlusion is slow enough to allow sufficient collateral circulation, the symptoms and signs may stabilize and the patient may be comfortable enough to forgo further therapy.[1]

Palliative Therapy

Short-term palliation of a symptomatic patient who does not want aggressive treatment may be achieved by elevating the head and using corticosteroids and diuresis. There are no definitive studies that prove the effectiveness of steroids, although they are potentially useful to treat respiratory compromise. Diuretics may give symptomatic relief of edema but can ultimately cause systemic complications, such as hypernatremia.[2]

Palliative measures include:


Chemotherapy is the treatment of choice for sensitive tumors such as lymphoma or small cell lung cancer. Superior vena cava syndrome does not appear to be an independent prognostic factor, and its presence should not change the treatment approach. Rapid initiation of chemotherapy can result in complete and partial response rates of the superior vena cava syndrome of more than 80% in small cell lung cancer patients.[2]


In most cases, superior vena cava syndrome arises when a thrombus forms in a partially occluded vein. In patients with a documented thrombus in the superior vena cava, treatment may include thrombectomy, with or without tissue plasminogen activator or other thrombolytic agents such as streptokinase or urokinase.

  • Most adult patients who develop superior vena cava syndrome have lung cancer, the treatment support measures that are developed for superior vena cava syndrome should take into account overall prognosis and other symptoms caused by the malignancy.


  1. Superior vena cava syndrome. Canadian Society of Cancer. Accessed on January 13, 2016
  2. 2.0 2.1 Uberoi R (2006). "Quality assurance guidelines for superior vena cava stenting in malignant disease". Cardiovasc Intervent Radiol. 29 (3): 319–22. doi:10.1007/s00270-005-0284-9. PMID 16502166.

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