Thrombosis of the superior vena cava treatment. Superior vena cava syndrome (SVVC) - symptoms and treatment. What causes superior vena cava syndrome

If there is an obstruction to venous outflow through the superior vena cava (SVC), swelling and cyanosis of the skin of the upper body and head occur. Subcutaneous vessels in this area expand, breathing becomes difficult, asthma attacks, bleeding and visual impairment occur. These signs are called kava syndrome, a symptom complex of SVC. Treatment requires surgery.

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Causes of vein compression

SVC is located between tissues and organs with a dense structure. It is surrounded by the inner surface of the chest, trachea, bronchial branches, aorta, a chain of lymph nodes. The vein itself is a vessel with thin walls and low blood pressure. Therefore, when outside or it easily loses patency.

If the outflow is disturbed, venous congestion extends to the brain, neck, arms, and the entire upper chest. Despite the presence of bypass routes - venous collaterals, they are unable to compensate for the functions of the main vein, since there is an intense blood flow in these areas.

The main factors that lead to the formation of kava syndrome:

extravasal (external, outside the vessel) pressure;
germination of the tumor node in the wall of the SVC;
thrombus blockage.

Pathologies that provoke the development of the syndrome include:

lung tissue cancer;
tumors of the lymph nodes (lymphogranulomas, lymphomas, metastasis from malignant neoplasms of the breast, genital organs);
benign processes, purulent inflammation of the thymus gland, trachea, esophagus;
silicosis (occupational lung disease);
compressive (constrictive) pericarditis;
complications after radiation therapy (fibrous nodules, adhesions);
enlargement of the thyroid gland (goiter retrosternal localization);
tuberculosis and syphilitic infections;
fungal infection of the lung tissue (histoplasmosis).

Often, the occurrence of kava syndrome is noted after prolonged catheterization of the vessel or.

Symptoms of the superior vena cava syndrome

Difficulty in blood circulation leads to an increase in pressure in the SVC system and venous vessels that dump blood into it. The severity of the symptoms that occur is related to the speed of the blockage and its location, and the possibilities of bypass circulation. Therefore, when the tumor is compressed or grows into the vessel, the signs increase slowly, and with thrombosis they progress rapidly.

Kava syndrome is characterized by three main clinical manifestations, they were called a triad - swelling, cyanosis of the skin and dilated veins of the arms and upper body, neck and head.

Patients can hardly be in a supine position, because due to increased pressure on the vein, such complaints arise:

heavy
chest pain,
wheezing breath,
bouts of shortness of breath,
cough,
difficulty in swallowing.

A high degree of venous hypertension against the background of vein dilation leads to the fact that the thin walls of the vessels cannot withstand and rupture. This causes bleeding from the nose, lungs, and esophagus. Brain symptoms are associated with a violation of the outflow of blood from the cranial cavity:

persistent headaches,
tinnitus,
increased sleepiness,
stunned,
convulsions,
fainting states.

Due to damage to the cranial nerves, double vision develops, blurred vision, eye fatigue, redness and tearing, hearing loss and auditory hallucinations.

Diagnostic methods

During the examination, dilated veins of the neck and chest, persistent swelling in this area, redness or cyanosis of the face and upper chest, hoarseness of the voice, and an increase in the tongue are determined. These manifestations become stronger when bending over and in the supine position. To clarify the location and cause of compression or blockage of the SVC, instrumental diagnostics are prescribed:

radiography,
CT or MRI
Ultrasound of the vessels of the neck,
measurement of venous pressure.

When examining an ophthalmologist, dilated and tortuous veins on the retina, congestion and edema in the area of the optic nerve head, and high intraocular pressure can be detected. If there is a suspicion of a lung tumor, then a bronchoscopy is prescribed, in which bronchial tissue and sputum are taken for examination. A biopsy of the lymph nodes, bone marrow, and mediastinal organs is performed.

Treatment of the syndrome

Until the cause is established, patients are prescribed symptomatic therapy, which temporarily facilitates breathing, relieves swelling of brain tissues and increases the reserve capacity of the body. For this purpose:

a diet with a sharp restriction of salt to 2 - 3 g per day;
oxygen inhalations;
(Hypothiazide, Furosemide);
glucocorticoids (Dexamethasone, Prednisolone, Metipred).

Then proceed to the treatment of the cause of the disease:

for malignant neoplasms - chemotherapy, radiation and surgery;
if blockage by a thrombus is detected - extraction, removal of part of the SVC and installation of a prosthesis from the great saphenous vein, thrombolytics (Streptokinase, Heparin, Warfarin).

If the tumor grows into the walls in a significant area, or for some other reason it is not possible to perform a radical operation, then to improve the outflow of blood, they use:

shunting to create a bypass;
installation of a stent on a narrowed segment.

Prognosis for patients

If it is possible to eliminate the cause of vein compression, then a significant decrease in cava syndrome is possible. With acute blockage, it increases, edema of brain tissues develops, thrombosis of cerebral vessels,. Due to a decrease in blood flow to the right side of the heart, oxygen starvation increases and the volume of circulating blood decreases.

These conditions often lead to the death of patients.. Adverse consequences also occur for patients with late diagnosis of malignant neoplasms.

For the syndrome of the superior vena cava, a characteristic triad of clinical signs is edema, cyanosis and dilated veins on the chest, head and neck. It develops with external compression of the vessel, fusion with a tumor formation, blockage by a blood clot.

With intensive progression or acute development, there are deaths. Treatment requires surgery to eliminate the cause of cava syndrome or restore patency of the SVC during reconstructive vascular operations.

Causes of the syndrome of compression of the superior vena cava

At the heart of the development of the syndrome of compression of the superior vena cava is compression of the vessel from the outside, thrombosis of the vein, germination of its wall by a malignant tumor. Such pathological conditions can be observed in the following cases:

progressive development of oncological diseases (lung cancer (adenocarcinoma, small cell carcinoma, often right-sided), breast cancer, non-Hodgkin's lymphomas, soft tissue sarcomas, melanoma);
some infectious diseases such as tuberculosis, syphilis, histioplasmosis;
development of retrosternal goiter in the pathology of the thyroid gland;
cardiovascular insufficiency;
iatrogenic factors;
idiopathic fibrous mediastinitis.

Symptoms of the syndrome of compression of the superior vena cava

The clinical picture of the syndrome of the superior vena cava can develop acutely or progress gradually. In this case, the patient may experience the following pathological symptoms:

headache;
cough;
dizziness;
nausea;
change in facial features;
dysphagia;
dyspnea;
drowsiness;
pain in the chest;
fainting;
convulsive syndrome;
swelling of the veins of the chest, upper limbs and neck;
swelling of the face;
cyanosis and plethora of the face and upper chest.

Diagnosis of superior vena cava syndrome

In the presence of the above clinical symptoms, a specialist may suspect the development of superior vena cava syndrome, however, to make a final diagnosis, it is important to perform the following studies:

radiography- carried out in the anterior and lateral projection allows you to identify the pathological focus located in the mediastinum. In this case, it becomes possible to determine its boundaries, the degree of distribution, to outline guidelines for the subsequent conduct of radiation therapy. In patients with this diagnosis, cardiomegaly, expansion of the boundaries of the upper mediastinum, the presence of pleural effusion, bilateral diffuse infiltrates, and changes in the mediastinum are most often detected;
doppler ultrasound- allows for differential diagnosis between the syndrome of compression of the superior vena cava and thrombosis;
phlebography- is carried out in order to localize the focus of impaired patency of the superior vena cava and assess the degree of its extent. This study also allows for differential diagnosis between vascular and extravascular lesions, to resolve the issue of operability, duration of treatment;
CT scan- allows you to get more valuable information about the location of the mediastinal organs.

Treatment of superior vena cava syndrome in Israel

The optimal treatment of the syndrome of compression of the superior vena cava is aimed at eliminating the causes that caused the onset of the disease, and takes into account the rate of progression of the pathological process. The key to successful therapy is to identify the etiology of the syndrome.

emergency events- are carried out with a rapid increase in vascular disorders and a threat to the life of the patient. The therapy is aimed at maintaining an unimpeded flow of air into the lungs, eliminating compression of the superior vena cava and mediastinal organs. In this case, the patient is given a position with an elevated head end, oxygen therapy is performed. In some cases, it may be necessary to perform a tracheostomy, intubation, and the introduction of anticonvulsants. Diuretics and corticosteroids are also used. This allows you to maintain the patient's condition and prevent the development of dangerous complications;
Radiation therapy- is a highly effective method for the treatment of compression syndrome of the superior vena cava. The most positive results can be obtained in the treatment of patients with small cell lung cancer. Chest irradiation should begin as early as possible. This allows you to slow down the development of the tumor node and prevent squeezing of large vessels by a growing neoplasm. Emergency radiation therapy is performed in case of pronounced signs of respiratory failure, such as stridor breathing, as well as in case of pathological symptoms from the central nervous system.
Chemotherapy- effective in the case when the etiology of the syndrome is based on compression of the superior vena cava tumor, sensitive to the effects of cytostatics. Most often, polychemotherapy is performed for breast cancer, myeloma, germ cell tumors, and lymphoproliferative diseases. The use of modern cytostatic agents according to special schemes allows Israeli specialists to obtain positive results of chemotherapy treatment in the vast majority of patients.
Combination Therapy- includes various combinations of radiation and chemotherapy methods. This effect is most effective in lymphoproliferative diseases, lung cancer. Step-by-step implementation of procedures and manipulations allows avoiding the development of dangerous complications of such aggressive treatment and increasing its effectiveness.
Medical treatment- consists in taking anticoagulants and fibrinolytics to stop an attack of the syndrome in the presence of thrombosis.
Surgery- can be indicated for a number of tumors when they are radically removed.

Qualitative treatment of the syndrome of compression of the upper vena cava is carried out in Israel by professionals in this field.

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The syndrome of the superior vena cava consists of a group of symptoms that develop due to a violation of blood flow in the superior vena cava, caused by compression from the outside or thrombosis of the vessel itself. SVCS is a manifestation of other diseases, in particular lung cancer. Therefore, when there are signs of superior vena cava syndrome, you should immediately consult a doctor and conduct a comprehensive examination. What is the cause of kava syndrome, symptoms and methods of therapy - in detail in the article.

Features of anatomy and provoking factors

The superior vena cava is located in the mediastinum. It is adjacent to the bronchi, chest wall, trachea, lymph nodes, aorta. The defeat of these organs or an increase in their size can cause compression of the indicated vessel and a violation of the outflow of blood from the upper body, i.e. from the head, heart, lungs, upper chest. Thus, when kava syndrome occurs, life-threatening conditions can occur. Manifestations of this disease often occur in men from 30 to 60 years. Such patients are usually faced by cardiologists, pulmonologists, phlebologists, oncologists. The mechanisms of occurrence of cava syndrome are tumor invasion into the vessel wall, compression from the outside, and thrombosis.

The most common cause of superior vena cava syndrome is lung cancer. However, tumor invasion into the wall of the superior vena cava can also be triggered by the following neoplasms:

Sarcoma.
Lymphoma.
Melanoma.
Tumors of the digestive organs located near the vein.
Mammary cancer.

Non-tumor causes of cava syndrome are as follows: retrosternal goiter, cardiovascular insufficiency, infectious diseases, purulent mediastinitis, post-radiation fibrosis, constrictive pericarditis, idiopathic mediastinal fibrosis, sarcoidosis, mediastinal teratoma, prolonged catheter in the superior vena cava, aortic aneurysm. Compression of the terminal section of the superior vena cava can cause expansion of the inferior vena cava, the causes of obstruction of blood flow in which are also quite diverse and no less dangerous to health.

Most often, the syndrome occurs due to lung cancer.

Main manifestations

The syndrome of impaired blood flow in the superior vena cava is characterized by three main syndromes: cyanosis, swelling, and an increase in the diameter of the superficial veins of the upper half of the body. Patients are concerned about shortness of breath at rest, difficulty swallowing, hoarseness, cough, swelling of the face and neck. All these symptoms are greatly aggravated at rest, so a person suffering from this ailment tends to take a semi-recumbent position.

Somewhat less often, symptoms of suffocation develop due to swelling of the larynx. This can lead to respiratory failure. Due to a violation of the outflow of venous blood, cerebral edema may develop. This causes symptoms such as headaches, convulsions, confusion, tinnitus, drowsiness, loss of consciousness.

Somewhat less often, symptoms of impaired functioning of the oculomotor and auditory nerves develop, expressed in lacrimation, double vision, exophthalmos, auditory hallucinations, hearing loss, and tinnitus.

An increase in pressure in the vein system leads to nasal, esophageal and pulmonary bleeding. In addition, there is swelling of the collar zone and upper limbs, cyanosis of the skin. These symptoms are clearly visible in the photo.

Ways to identify the disease

In addition to standard examination methods, including patient interviews, visual examination and laboratory tests, diagnostic methods such as:

Radiography in two projections.
Computed and magnetic tomogram.

Additional research methods aimed at detecting the cause of the syndrome include: examination of the fundus, measurement of intraocular pressure, bronchoscopy, sputum analysis, ultrasound of the carotid and supraclavicular veins, sternal puncture. In case of emergency, it is possible to perform diagnostic thoracoscopy and parasternal thoracotomy.

To identify the disease, you can use the method of phlebography.

Therapy Methods

Treatment of the superior vena cava syndrome includes complex therapy aimed at eliminating the cause of this condition and alleviating the patient's condition. This can be achieved using conservative and surgical methods.

Conservative treatment includes:

Oxygen inhalations used for airway obstruction, as well as tracheostomy, tracheal intubation.
With cerebral edema, diuretics and glucocorticosteroids are prescribed. If necessary, anticonvulsants are added to the treatment.
In the presence of a malignant neoplasm, treatment should begin with radiation therapy. When intercellular lung cancer is combined with lymphoma, chemotherapy is added to radiation therapy.
Percutaneous stenting helps to manage the lack of air.

If the cause of blood flow disturbance in the superior vena cava is a thrombus, then treatment is carried out with fibrinolytic drugs. In the absence of the effect of conservative treatment or with a significant deterioration in the health of the patient, surgical intervention is performed.

If the superior vena cava is compressed from the outside, then a radical removal of the tumor is performed. If such surgical treatment is not possible, then palliative surgery is performed. Among the methods aimed at improving the patient's condition, the following are distinguished: bypass shunting, stenting, percutaneous endovascular balloon angioplasty, removal of a part of the neoplasm for the purpose of decompression.

Thus, the syndrome resulting from impaired blood flow in the superior vena cava can manifest itself with several ambiguous signs at once. Therefore, it is important to know its main symptoms. Depending on the severity of the condition and the cause of its occurrence, a method of treatment is selected, respectively, the earlier the disease causing this syndrome is detected, the more complications can be avoided.

Not everyone knows what it is, and many have not heard until the moment problems arise. Superior vena cava compression syndrome is a collection of symptoms caused by compression or partial blockage of a vein that carries blood from the head and neck to the upper body, arms, and heart (abbreviated as SVCS). Most often, and this is in 95% of cases, it is caused by cancer.

Symptoms

This ailment develops not only due to compression of the vein, but also because a blood clot occurs in it, making it difficult for the outflow of blood from the head and chest.
A person has the following symptoms:

Constantly sleepy.
Headache attacks.
Swelling on the face, neck, and also in the chest area.
Pain in the chest.
The face is purplish blue.
Difficulty in breathing.
Swollen throat.
Pulmonary edema.
Feeling close to fainting.
Whistling is heard during breathing.
Cough.
Expansion of superficial veins.
The skin on the chest and arms acquires a bluish color.
Seizures.

These signs are basic, but there are also secondary ones:

Hearing and vision are impaired.
auditory hallucinations.
Eyes tear.

Symptoms are more clearly manifested at the moment of tilting forward, as well as when raising the arms up.

The severity of the expression of symptoms directly depends on the rate of progression of the disease. The stronger the compression, the more the collateral circulation is disturbed, and it is the main source of oxygen supplied to the organs. The main factor causing this condition is lung cancer. Signs of compression become clearly visible after a short time, only 3-4 weeks. In this case, blood pressure rises to 200-500 mm, water. Art.

It's important to know. Men aged 30 to 60 years are much more likely to be affected by this pathology, unlike women.

Causes of SVCS

There are many of them, but experts highlight some of the most basic:

The external nature of the vein squeezing.
Thrombus.
Compressive pericarditis.
Lung cancer.
Melanoma.
Cancer of the lymph nodes (lymphoma).
Silicosis.
Tumor of organs located in the region of the diaphragm.
Sarcoma.
Tuberculosis infection.
mediastinal teratoma.
Oncology of the breast.
Cardiovascular diseases.
proliferation of fibrous tissue.

It happens that the human body itself causes such changes, reacting in this way to surgery or prolonged use of a venous catheter.

Diagnostic methods

Before starting the procedures, the doctor must learn the medical history and find out the reasons for the development of the syndrome.

It is diagnosed as follows:

A chest x-ray is taken. Pictures are taken in different projections.
Mandatory tomography - spiral, MRI and CT.
Phlebography - is carried out in order to identify the location of the disease.
Doppler ultrasonography is performed.
The patient undergoes a bronchoscopy along with a biopsy - it reveals the factors due to which the disease has formed.
Sputum is examined in the laboratory.

If necessary, the specialist conducting the study prescribes thoracoscopy and mediastinoscopy, and by referring the patient to an ophthalmologist for a consultation, he will measure intraocular pressure. In addition, it is necessary to distinguish pathology from heart failure. After the doctor receives all the tests, he will be able to determine exactly the direction of therapy that is required for this particular patient.

How the disease is treated

Therapy is selected based on the speed with which the disease and symptoms develop.
In more than 50% of cases, the syndrome begins to develop before the patient has been diagnosed. In order for the doctor to conduct effective therapy, he needs to determine the initial process that became the cause.

In the case when the disease is severe, and there is a threat to the life of the patient, therapy is started urgently, without making the main diagnosis. The main goal is to stop the signs of the disease. Half of all cases of SVCS are treatable.

Basic Methods

medical

Drug therapy is very effective in treating pressure syndrome. For this, anticoagulants or fibrinolytic medications are used. These funds are prescribed only in case of detection of thrombosis, during phlebography, or when the effectiveness of the measures taken is too low.

Surgical

Among the methods of treatment of thrombosis of the superior vena cava, from a malignant tumor by surgical intervention, the most effective is percutaneous endovascular balloon angioplasty, together with the installation of a stent in the place where the venous lumen narrows. To get the maximum effect from the treatment, it must be started at an early stage of the disease.

Recommendations for pregnant women with compression syndrome of the inferior vena cava

The inferior vena cava is located along the length of the spine, has a large diameter and venous blood is drained from the internal organs and legs through it. When the uterus is enlarged, it is subjected to compression. As a result, the outflow of blood to the heart decreases, and it circulates in smaller volumes through the lungs.

Doctors recommend expectant mothers:

Sleep on your left side.
Place pillows made for pregnant women under your back.
Walking more often will improve venous outflow.
Do exercises in the pool, the water helps to squeeze the blood out of the legs.

Pregnant women with this syndrome should not sleep on their backs and do physical exercises.

No matter how scary the symptoms may seem, you need to remember that, despite the complexity of SVCS, it is treated. Well, if we take into account that today is the 21st century and technologies in medicine continue to develop, then this is not a sentence. In order to somehow protect yourself, it will be useful to undergo an annual examination.

The syndrome of the superior vena cava appears when there is a violation of the outflow of venous blood from the upper parts of the body and difficulty in blood circulation in the system of the superior vena cava itself. The manifestation of the condition can be seen by the occurrence of cyanosis - blue skin, the appearance of shortness of breath, a change in the timbre of the voice - it becomes hoarse, a constant desire to cough.The face and neck are swollen.

Characteristics of the symptom complex

In addition to the above changes, additional symptoms appear:

headache;
dyspnea;
constant sleepiness;
chest pain;
labored breathing;
convulsions;
fainting state.

The secondary symptoms of the syndrome of the superior vena cava include complaints of blurred vision and hearing, noise in the organ of hearing and auditory hallucinations, and recurrent lacrimation.

The severity of symptoms may be different - it all depends on the rate of development of pathological changes. The more pronounced the degree of compression of the vein, the smaller the gap between the vena cava and the surrounding tissues, the more pronounced the violation of collateral circulation.

With the help of collateral circulation, the body adapts to a state during which, due to blockage of the main duct - a large vein or artery - the body tries to convey the necessary amount of oxygen to a certain organ through the lateral vessels.

If such a process is impossible, pathological changes in the brain tissues begin.

Factors provoking the onset of the syndrome

The main causes provoking the occurrence of pathological processes:

narrowing of the superior vena cava as a result of thrombosis;
compression of this vein from the outside;
formation in the venous wall of a malignant neoplasm.

These causes cause an increase in mediastinal tissues or the appearance of venous obstruction within the vena cava. Oncological changes in the lungs in general, and cancer of the right lung in particular, are 80% the cause of the syndrome of compression of the superior vena cava.

Other malignant tumors can also be distinguished:

lymphomas of various types;
tumors of the digestive organs located in the area of the diaphragm;
mammary cancer;
sarcomas, especially malignant fibrous histiocyoma;
melanoma.

There are other diseases during which the appearance of the syndrome of the superior vena cava is observed.

Severe insufficiency of the cardiovascular system;
Various types of thrombosis resulting from traumatic effects on the sternum or secondary damage to the mediastinal vessels;
The introduction of pathogenic flora that caused infectious diseases such as syphilis, histioplasmosis; tuberculosis;
Retrosternal goiter;
Iatrogenic causes: that is, diseases that have arisen as a result of inadequate perception of the patient's body of medical manipulations. Iatrogenic diseases can develop even with insufficiently correct treatment of the patient by medical personnel;
Idiopathic fibrous mediastinitis is the proliferation of fibrous tissue with inflammation of the mediastinal tissue.

Diagnosis of the disease

Identification of the disease begins with an external examination of the patient and an assessment of the general condition. It is possible to suspect the presence of the disease already by the clinical picture: an expanded network of vessels in the thoracic region is visible to the naked eye, while swelling of the face is expressed, its color is changed - the skin acquires a red or purple-bluish hue.

To clarify the diagnosis, first of all, a chest x-ray in 2 projections is prescribed.

computer;
magnetic resonance;
spiral.

Sometimes phlebography is performed.

It is necessary to consult an ophthalmologist for examination of the fundus. During this examination, the tortuosity and expansion of the retinal veins are determined, intraocular pressure is measured, and the severity of edema of the peripapillary region is determined.

For differential diagnosis of the degree of thrombosis and internal obstruction of the superior vena cava, ultrasonography of the supraclavicular veins and carotid arteries is performed.

Sometimes a bronchoscopy is required, during which sputum will be collected for analysis to determine the presence or absence of atypical cells. An analysis of the state of washing water from the bronchi and a biopsy of the lymph nodes is carried out.

Kava syndrome - the syndrome of the superior vena cava - is additionally investigated when performing differential diagnosis, if the clinical picture is not expressed: that is, in the presence of heart failure, peripheral edema and ascites are not expressed - fluid does not accumulate in the pleura.

Treatment of cava syndrome

If the diagnosis is established: kava syndrome, then complex treatment is carried out, which includes the following therapeutic manipulations:

During symptomatic treatment, airway obstruction is eliminated. To relieve hypoxia, oxygen inhalations are prescribed, to reduce cerebral edema, drugs are prescribed: glucocorticoids, diuretics. In the presence of a benign tumor, it is advisable to eliminate the cause with a surgical method; when a malignant tumor is detected, treatment begins with radiation therapy. If the cause of the obstruction is not removed, therapeutic measures will bring only short-term relief;
Quickly eliminates the lack of air percutaneous stent placement;
Radiation therapy is the main method of treatment for cava syndrome caused by the formation of malignant tumors. Patients feel relief after 3-7 days after the start of therapy, even if the patency in the vena cava itself is not restored;
In patients with intercellular lung cancer and lymphomas, radiation therapy is used in combination with chemotherapy.

There are several types of surgery for kava syndrome.

radical decompression. During it, the tumor that compresses the vein is removed. She is the most efficient. Thrombectomy - during it, blood clots are simply removed from the artery, making it difficult for normal blood supply.

Installation of a venous homograft. During it, a bypass of the axillary or left femoral vein is performed or a venous catheter is installed for a long time. The vein graft is the patient's own tissue and is made from the great saphenous vein of the thigh.

Operations of the latter type are practiced when it is impossible to perform a radical surgical intervention to eliminate the main cause, due to which the blood supply to the upper body began to be disturbed.