Superior vena cava (SVC) syndrome is a collection of clinical signs and symptoms resulting from either partial or complete obstruction of blood flow through the SVC. This obstruction is most commonly a result of thrombus formation or tumor infiltration of the vessel wall.

1. PRESENTER: ROMANUS MAPUNDA
MSC. ONCOLOGY NURSING

2.  OUTLINE
 Introduction
 Pathophysiology
 Anatomy
 Epidemiology
 Etiology/Risk factors
 Clinical
manifestation
 Diagnostic work up
 Treatment
 Prevention and
control approach

3.  Superior vena cava (SVC) syndrome is a
collection of clinical signs and symptoms
resulting from either partial or complete
obstruction of blood flow through the SVC.
 This obstruction is most commonly a result of
thrombus formation or tumor infiltration of
the vessel wall.

4.  Today, this syndrome is most commonly seen
secondary to malignancy, although there has
been a more recent rise in benign etiologies.
 Increased upper body venous pressures
results to venous congestion.

5.  Malignant diseases causing SVCO are Lung
cancer (>SCLC and SCC histology cases) which
accounts for nearly 85% of all cases
 Followed by Lymphomas mainly NHL 10-15%,
with less than 2% occurs in patients with
Thymomas and mediastinal Germ cell
tumours.

6.  Non malignancy causes of SVCO includes
retrosternal goitre, sarcoidosis, tuberculosis,
mediastinal post Irradiation, Idiopathic
fibrosis.
 There is also an increase of SVCO in cancer
patents with long term central venous
catheters

7.  Mechanisms has divided into three categories
which are compromised vessel anatomy,
impaired venous flow, and diminished vessel
wall integrity (can core exist in PT with SVC
syndrome)
 Extrinsic compression and obstruction of the
SVC by a mass in the mediastinum is the most
common cause of SVC syndrome

8.  This is often associated with malignancy;
however, there are a variety of nonmalignant
masses.
 A growing proportion of SVC syndromes are
now associated with occlusive venous
thrombus formation that compromises venous
flow back to the heart.

9.  The increasing use of indwelling intravascular
devices such as catheters and pacemakers
leads have played a major role in this growth.
 Resultant venous wall inflammation, fibrosis,
and eventual thrombus lead to stenosis of the
vessel itself

10.  The SVC is the major drainage vessel for
venous blood(2cm and a length of
approximately 6-7cm) from the head, neck,
upper extremities, and upper thorax.
 It arises from the union of the left and right
brachiocephalic veins, posterior to the first
right costal cartilage.
 It descends vertically through the superior
mediastinum, behind the intercostal spaces
and to the right of the aorta and trachea.
 At the level of the second costal cartilage,
the SVC enters the middle mediastinum and
becomes surrounded by the fibrous
pericardium.
 It terminates by emptying into the superior
aspect of the right atrium at the level of the
third costal cartilage.
 It is a thin-walled, low-pressure, vascular
structure. This wall is easily compressed as
it traverses the right side of the
mediastinum.

11. United States statistics
 The incidence of SVCS within the United States is
roughly 15,000 cases per year
 SVCS develops in 5-10% of patients with a right-side
malignant intrathoracic mass lesion.
 In 1969, Salsali and Cliffton observed SVCS in 4.2% of
4960 patients with lung cancer;
 In 1987, Armstrong and Perez found SVCS in 1.9% of 952
patients with lymphoma.

12. Age and sex demographics
 Malignant causes of SVCS are predominantly
observed in individuals aged 40-60 years.
 Benign causes (aged 30-40 years).
 SVC in the pediatric age group is rare
 Malignant causes of SVCS are most commonly
observed in males ( WHY )
 In contrast, cases related to benign causes
show no sex-related differences in
frequency.

13.  The most common etiology of SVCS is
malignancy.
 Infectious causes ( syphilis, tuberculosis, and
fungus
 The most common cause of malignancy-
related SVCS is bronchogenic carcinoma,
which accounts for nearly 80% of cases.
 Lymphoma accounts for approximately 15% of
cases.
 dialysis catheters and pacemaker are
associated with SVCS. ( WHY )

15. Dyspnea
cough
distended neck veins
dyspnea
orthopnea
distended chest vein collaterals
upper extremity swelling

17.  Stridor
 Hoarseness
 Dysphagia
 Pleural effusion
 Headache, nausea
 Lightheadedness
 Syncope
 Change in vision,
 Altered mental status
 Upper body edema
 Cyanosis and coma
 Horner’s syndrome,
symptoms on one side of
face
 Some rare but serious
clinical consequences
reported in SVC syndrome
include
 cerebral edema and upper
respiratory compromise
secondary to edema of the
larynx and pharynx.

18. The characteristic physical findings of SVCS
include
 venous distention of the neck and chest wall,
facial edema, upper-extremity edema, mental
changes, cyanosis, papilledema, stupor, and
even coma.
 Bending forward or lying down may aggravate
the symptoms and signs.

19. o Chest X-ray.
o CT and MRI
o Invasive contrast venography.
o Sputum cytology.
o Thoracentesis.
o Bronchoscopy.
o Needle aspiration of a peripheral
lymph node, or mediastinoscopy

20.  Elevation of the patient’s head as a simple
maneuver with the goal of decreasing venous
pressure and supplemental oxygen if indicated.
 For patients with thrombus related to an
indwelling intravascular device, removal
should be considered along with
anticoagulation (Heparin or Warfarin) therapy
and catheter-directed thrombolysis

21.  Emergency treatment is indicated when brain
edema, decreased cardiac output, or upper
airway edema is present
 Steroids can be started ( Dexamethasone)
 Diuretics

22. Radiation therapy (standard treatment for most
patients with SVCS)
o Dose - 20Gy/ 5 #s or 30Gys/10#s or 37.5Gys/15#s
o The radiation dose depends on tumor size and
radioresponsiveness.
o The radiation portal should include a 2-cm
margin around the tumor.

23.  When SVCS is due to thrombus around a central
venous catheter
 Patients may be treated with thrombolytics or
anticoagulants (eg, heparin or oral
anticoagulants).
Chemotherapy
o For chemo sensitive tumors.

24.  Surgical care:
1. Surgical bypass
 May be a useful way to palliate
symptoms(ie, after failure of radiation
therapy and chemotherapy)
2. Stenting
 Percutaneous transluminal angioplasty
(PTA), thrombolysis, or some combination
 In most patients with SVCS, stenting of the
SVC provides rapid symptomatic relief
within few days

25.  Cardiac tamponade
 Mediastinitis
 Thoracic aortic aneurysm
 Tuberculosis

26.  Complications of SVCS may include the
following:
 Laryngeal edema
 Cerebral edema
 Decreased cardiac output with hypotension
 Pulmonary embolism (when an associated
thrombus is present)

27.  Major considerations in the nursing care of
patients with SVCS include
 Recognition of high-risk patients
 Facilitation and coordination of diagnostic
procedures
 Assessment of respiratory, cardiac and neurologic
systems
 Administration of therapy
 Provision of emotional and psychosocial support, and
Patient education.

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6. Superior Vena Cava Syndrome (2024)
https://emedicine.medscape.com/article/460865-differential
7. Superior Vena Cava Syndrome (2024)
https://www.ncbi.nlm.nih.gov/books/NBK441981/