Endovascular Treatment of Complex Superior Vena Cava Syndrome

Background

Superior vena cava (SVC) syndrome is caused by central venous obstruction and may occur in patients with advanced cancer. Endovascular treatment can restore venous flow and rapidly improve symptoms.

Case Presentation

A 74-year-old man with squamous cell carcinoma of the tongue presented with marked facial swelling and redness. Contrast-enhanced CT showed a heterogeneous soft-tissue mass in the right lower neck extending into the upper mediastinum. There was occlusion of the right jugular vein and right subclavian-brachiocephalic venous system, with severe narrowing at the left brachiocephalic vein-SVC junction and marked facial and neck edema.

Initial venography from the right upper extremity showed severe venous obstruction with extensive collateral veins. Right common femoral venous access was then obtained. Using a bidirectional approach, the occlusion was crossed and through-and-through wire access was created.

Balloon angioplasty was performed, followed by stent placement in the right brachiocephalic vein extending into the upper SVC and in the left brachiocephalic vein toward the SVC. Final venography showed patent stents with good central venous flow, followed by improvement in facial swelling and redness.

Conclusion

Endovascular treatment can rapidly improve complex SVC syndrome. A bidirectional approach with through-and-through wire access can help cross difficult venous occlusions and allow successful angioplasty and stenting.