Superior vena cava syndrome surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Surgical options include stent placement and surgical bypass.

Surgery

Stent Placement

There have been numerous small studies using 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

Surgical bypass of an obstructed SVC 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.