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Background: Superior vena cava syndrome is defined as the lack of central venous inflow through the superior vena cava and can present a life-threatening situation. The acute situation is characterized by dyspnea and requires a fast and effective treatment., Methods: Using two case reports, endovascular stent therapy for the treatment of acute and subacute superior vena cava syndrome is explained and discussed., Results: In the first case, we introduce a patient with acute dyspnea due to decompensation of a chronic thrombosis of the superior vena cava. The second case displayed the same acute symptoms consisting of acute dyspnea and upper venous congestion due to a tumor-related compression of the superior vena cava. In both cases, the acute situation of superior vena cava syndrome was successfully treated by stent implantation., Conclusion: Endovascular treatment of superior vena cava syndrome is an effective option with a high technical success rate., (© Georg Thieme Verlag KG Stuttgart · New York.)

We report on a young patient with cancer of unknown primary origin with occlusion of the superior vena cava due to mediastinal lymphadenopathy. In order to continue infusion of palliative chemotherapy a central venous port system was radiologically implanted via a right femoral vein access. The port reservoir was placed craniomedial to the right anterior superior iliac spine. This approach was considered convenient in respect to comfort in wearing trousers. In addition, at this site the port reservoir is easily accessible for medical staff. It was possible to draw blood via the port system and to infuse the chemotherapy without complications. The present case shows that in cases of occlusion of the superior vena cava radiological implantation of a central venous port system via a femoral vein access is a useful option.

We report an implantation of a cardiac re-synchronization system in a patient with persistent left superior vena cava. This anomaly occurs in 0.3 to 0.5% of healthy individuals and remains usually asymptomatic. Variations of the superior vena cava should be considered in venous catheterization and other procedures such as implantation of pacemaker and ICD systems as well as port catheter insertion. In re-synchronization systems, persistent left superior vena cava can be an obstacle for cannulation of the coronary sinus and placement of a transvenous left ventricular lead.

A 36-year old woman was presented to our hospital with congenital ventricular septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction, a transesophageal echocardiographic (TEE) baseline examination was performed, showing a severely dilated coronary sinus (CS) measuring approximately 3 cm (abnormal >1 cm). We suggested a persistent left superior vena cava (PLSVC) draining into the CS. PLSVC is a common venous congenital anomaly, with a reported incidence of 0.5% in general population and in 3-5 % of patients with congenital heart defect. Injection of echo-contrast solution in a left arm vein, visualizing microbubbles passing through the PLSVC into the CS confirmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contraindication for retrograde cardioplegia because of the loss of cardioplegia into the PLSVC resulting in a inadequate myocardial protection. It may be difficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrhythmias. A chest radiograph shows the anomalous course of the PAC along the left heart.

Purpose: Venous congestion of the superior or inferior caval system has to be considered as a medical emergency. The results of various recanalization procedures and their utility are analyzed., Patients and Methods: 176 patients with superior and 28 with inferior caval obstruction were treated with Gianturco-Z (n = 39) and Wall Stents (n = 207) respectively. Balloon venoplasty was performed prior to stent implanation. In 27 cases, local thrombolysis with urokinase was employed., Results: Interventional procedures were successful in 198 and without success in 6 patients. In most patients, symptoms were relieved during or early after recanalization. No major complications were found., Discussion: Balloon angioplasty with stent placement and local thrombolysis are successful in the treatment of superior and inferior caval obstruction. Self-expanding Wallstents are superior to Gianturco-Z-stents. Oncologists should be made familiar with this type of treatment.

In about 90% of superior vena caval obstructions the cause is a neoplasm, generally a carcinoma of the right upper lobe. Fewer than 5 percent are due to inflammatory disease of the mediastinum. A case of idiopathic, fibrosing mediastinitis with occlusion of the superior vena cava is described. The clinical symptoms, radiographic finding, diagnostic and therapeutic aspects are discussed.

Aim of Study: To analyse results obtained in the palliative treatment of obstruction of the upper inflow veins by stent implantation in patients with bronchial carcinoma., Patients and Methods: Stents were implanted in 14 patients with upper venous obstruction due to bronchial carcinoma (three women, eleven men: mean age 64 [48-74] years), 4 of the superior vena cava (SVC), 6 of the SVC and brachiocephalic vein, 4 of the SVC and subclavian vein. To prevent thromboembolic phenomena all patients received heparin in therapeutic doses for 1-3 days from the time of stents implantation., Results: Treatment was successful (regression of the clinical signs) in 12 of the 14 patients. Six patients died, without recurrence of the clinical signs, an average of 141 (10-420) days after the procedure. Mean survival time of the six patients who remained without symptoms was 3 months (longest interval 9 months). In one patient thrombotic occlusion of the SVC occurred 6 days after stent implantation. However, local thrombolysis successfully re-opened the vessel. Renewed upper vein obstruction occurred in two patients during follow-up. None of the stent filaments fractured and there was no stent dislocation., Conclusion: With a success rate of 86% stent implantation proved to be a sparing procedure in the palliative treatment of upper inflow vein obstruction, especially in patients with extensive malignant disease.

We report on a 52-year old male patient who underwent implantation of an insulin pump because he had diabetes and in whom superior vena cava syndrome developed as a long-term complication. After unsuccessful lysis therapy superficial femoral vein was implanted to form a bypass from the internal jugular vein to the right atrium. The postoperative course was uneventful from the aspects of both the bypass and the leg after explantation of the superficial femoral vein. The bypass is still patent 7 months after the operation, and the patient has no symptoms. Autogenous superficial femoral vein can be used successfully in the reconstruction of large venous vessels. It should be the graft of choice for young patients with benign diseases. We compare our result and those obtained with different substitutes described in the literature that have been used for reconstruction in superior vena cava syndrome.

Superior vena cava syndrome due to transvenous pacing leads is a rare event. Local infection as well as multiple leads are important predisposing factors. The case of a patient with superior caval syndrome after multiple complicated permanent pacemaker insertions is presented. Medical treatment was unsuccessful. At operation a fibrous narrowing of the vena cava superior was found. The two leads (DDD-pacemaker) were left in place. A Goretex patch was used for enlargement of the anterior wall of the vein. Postoperatively, the patient remained free of symptoms and the vein was patent angiographically. In case of failure of medical management surgical correction should be attempted without delay.

Surgical problems in treatment of superior vena cava syndrome are discussed by our population of 15 patients and the literature. Nine patients which suffered from caval thrombosis were managed by thrombectomy. In four cases superior vena cava was bypassed or replaced by PTFE (Gore-Tex) tubular grafts successfully. Whereas autologous vein as spiral composite graft or complete venous conduit might be preferred by reason of excellent longtime patency rates, the every time available PTFE vascular prosthesis appears to be an efficient synthetic material for replacement of superior vena cava.

Twenty-nine reconstructions of the vena cava superior were performed: twice due to obliterating mediastinopericarditis, twice because of post-traumatic thrombosis, 4 times because of iatrogenic thrombosis, once because of an arteriovenous fistula and 24 times due to malignant tumours. In nine of the latter cases a large resection with prosthetic repair of the vena cava superior was necessary; one of these patients died and the others had no recurrence of thrombosis.

Primary mediastinal seminoma is an uncommon lesion and should be included in the differential diagnosis of mediastinal tumors. Symptoms and signs may not be clear and in most cases the diagnosis is made by sternotomy or thoracotomy. Our recommendation is that patients with primary mediastinal seminoma should undergo curative resection or reductive surgery. Curative resection should be followed by radiation therapy. Chemotherapy with cisplatin-containing combinations should be reserved for patients who have metastases at the time of diagnosis.

A case of sarcoidosis is reported, which began 25 years ago. As a late complication the patient developed compression syndrome of the superior caval vein, which was caused by swelling of the lymph nodes. After surgical treatment, which was carried out by removing the regional lymph nodes and implantation of a dacron prosthesis, stenosis occurred within the proximal part of the prosthesis, which was treated by the PTA technique according to the Dotter method.

Report about three cases of resection of the superior vena cava for tumor stenosis or occlusion. In one patient no reconstruction was performed while in the other two interposition of an armored PTFE-prosthesis between right brachio-cephalic vein and vena cava superior was carried out. In agreement with other authors it is concluded that best results can be obtained by reconstruction with a PTFE-prosthesis or autologous vein graft.