Syndrome of the superior vena cava in children. Syndrome of the inferior vena cava. Symptoms of the superior vena cava syndrome

The superior vena cava is the vein that carries waste blood from the upper body to the heart for re-oxygenation.

Superior vena cava syndrome is often a secondary problem that is caused by a cancerous tumor or blood clot blocking blood flow through the vein.

This syndrome used to be considered a medical emergency. However, now doctors do not think so. However, people who have symptoms of this syndrome should be seen by a doctor promptly.

What is superior vena cava syndrome?

The superior vena cava is the larger of the two veins that carry oxygen-depleted blood back to the heart.

The superior vena cava carries waste blood from the head and upper body to the right atrium (upper chamber). This vein is located in the middle of the chest and is surrounded by lymph nodes.

Superior vena cava syndrome is the name given to symptoms that occur when blood flow through the superior vena cava is obstructed or blocked.

Symptoms include trouble breathing, swelling of the upper body, and dizziness.

The reasons

Superior vena cava syndrome is a complication of another medical problem, such as a swollen lymph node that obstructs blood flow through the vein, or a tumor.

Common causes of superior vena cava syndrome include:

non-Hodgkin's lymphomas;
lungs' cancer.

Less common causes of superior vena cava syndrome include:

metastatic breast cancer;
colon cancer;
esophageal carcinoma;
thyroid cancer;
Hodgkin's lymphoma;
blood clots due to an intravenous catheter or pacemaker;
serious respiratory tract infections such as tuberculosis;
certain diseases of the immune system, such as Adamantiades-Behçet disease.

Symptoms

If the blood flow obstruction that caused the syndrome does not reach a complete blockage, the person may not have symptoms.

More often, a person with a partial blockage has mild symptoms that they may not notice.

If the blockage is complete or worsens quickly, the person is more likely to experience severe symptoms.

Symptoms may include a combination of the following:

cough;
difficulty breathing or swallowing;
hoarseness;
chest pain;
coughing up blood;
swollen veins in the neck or chest;
swelling of the hands;
swelling of the face;
stridor or sniffle;
nausea;
dizziness;
redness on the chest or neck.

Syndrome of the superior vena cava in children

Although the superior vena cava syndrome is rare in children, it is a medical emergency. A child's windpipe is smaller and less rigid than an adult's, making it more prone to swelling quickly and causing breathing problems. The symptoms are often similar to those in adults and are often the result of lymphoma (cancer of the lymphatic system).

Symptoms during pregnancy

Pregnant women in the late second and third trimesters may have a condition similar to this syndrome. Symptoms occur if the inferior vena cava (the smaller of the two veins that carries oxygen-depleted blood back to the heart) becomes compressed due to pressure from the fetus and enlarged uterus.

A pregnant woman may experience dizziness and low blood pressure when lying flat on her back. If you lie on your left side, often the symptoms disappear.

Diagnostics

If a doctor suspects a person has superior vena cava syndrome, they will first do a physical exam. Examination may reveal enlarged veins in the chest and neck.

If the results of the examination suggest the presence of such a syndrome, the doctor will most likely prescribe additional examinations:

chest x-ray to detect tumors in the lungs or enlargements in the chest;
computed tomography to detect blockage;
venography - an x-ray of the veins after an injection of a special dye that makes the veins visible;
ultrasound to look for blood clots in the upper extremities.

If a tumor is found to be the cause of the blockage, the doctor may order a biopsy to determine what kind of tumor is causing the problem. For proper treatment, it is important to know whether the tumor is cancerous or benign.

Treatment

In most cases of superior vena cava syndrome, treatment is aimed at reducing the symptoms and the tumor causing the blockage. If the case is mild, waiting under observation may be the only recommended treatment.

Many people with this syndrome see significant improvements in their symptoms if they hold their heads high and use supplemental oxygen. Some doctors also try to reduce swelling by prescribing steroids.

Most treatments for a syndrome focus on the cause of the syndrome. Since most cases are due to cancer, appropriate treatment is key. Treatment will vary depending on the type of cancer and may include a combination of chemotherapy and radiation.

In cases where the syndrome is caused by a blood clot, blood thinners may be prescribed. A stent may be used to open the vein. In rare cases, a bypass may be required.

Forecast

Usually, the symptoms of superior vena cava syndrome have a clear improvement after a month of treatment. However, since most cases are caused by cancer, the overall prognosis is highly dependent on the type and stage of the cancer.

Superior vena cava syndrome (SVCS) or cava syndrome is a whole complex of symptoms that occur as a result of impaired blood flow in the basin of the vessel of the same name. Due to circulatory disorders in this area, the outflow of blood from the venous vessels in the upper parts of the body is difficult. This pathology is manifested by blueness of the skin, mucous membranes, dilatation of the saphenous veins, shortness of breath, hoarseness, cough, etc. You can recognize the patient by the flabby head, neck, arms, upper half of the torso.

SVCS is a serious pathology that threatens the life of the patient. When the integrity of the vein wall is damaged, an acute violation of blood flow occurs. When the pressure in the vessel rises to 250 mm Hg / st, medical assistance is indispensable, otherwise the patient will die. That is why it is so important to detect characteristic symptoms in time and transport the patient to a medical facility.

Kava syndrome - basic information

To better understand what superior vena cava syndrome is, you need to delve into the anatomy of the chest. The superior vena cava (SVC) is an important blood vessel located in the middle mediastinum, and around it is the chest wall, trachea, bronchi, aorta, and lymph nodes. SVC takes blood from the head, neck, arms, upper half of the body. There is low pressure in this vessel, and this is quite normal. It is for this reason that any pathology of nearby tissues can damage the thin wall of the venous vessel and seriously disrupt blood flow.

Thanks to the system of anastomoses (the junction of two blood vessels), the body independently copes with the violation of the patency of the SVC. But when the pressure rises to 250 mm Hg / st, then a crisis sets in. This is a very dangerous condition, so the patient needs urgent medical care, otherwise death is inevitable.

SVCS is a secondary disease that complicates many pathologies associated with damage to the organs of the chest cavity. The pathology is based on compression or SVC, as a result of which the outflow of blood through the veins from the head, neck, arms and organs of the upper half of the torso is disturbed. Such a violation threatens with dangerous complications. At risk are men from 30 to 60 years old.

The superior vena cava is located in the middle mediastinum, next to the aorta, trachea and bronchi

The reasons

To understand how the syndrome of compression of the superior vena cava occurs, you need to know how it functions. The superior and inferior veins empty into the right atrium. During the relaxation of the atrium, oxygen-poor blood is pumped into it. From there, it is fed into the right ventricle, and then into the pulmonary artery, and is saturated with oxygen in the lungs. Then arterial (oxygenated) blood returns through 4 pulmonary venous vessels to the left atrium, from where it goes to the left ventricle, then to the aorta and to all organs.

The inferior vena cava takes the used blood from the organs that are located under the diaphragm, and the SVC from the organs above the diaphragm. The pools of these vessels are clearly separated, but there are fistulas between them. With stenosis of the SVC, excess blood is discharged through the anastomoses into the inferior vena cava.

Superior vena cava syndrome is provoked by malignant tumors and thrombosis

The walls of the SVC are very thin, so the blood from the head moves almost under the influence of gravity. The muscles of the upper limbs help speed up its movement. Near the SVC there is a powerful aorta, a strong trachea and bronchi, a large number of lymph nodes. With the development of metastases in these anatomical structures, the SVC subsides and no longer copes with its function.

Malignant formations in the lymph nodes deform them, due to which the vein is compressed. With a tumor lesion of the mediastinum due to cancer of the lymphatic system or lung, the patency of the SVC is impaired. In addition to the tumor, there is a possibility of vascular thrombosis due to tumor lesions of the digestive tract or ovaries. Thus, venous congestion is provoked by tumors, metastases, and blood clots.

Symptoms

Symptoms of the superior vena cava syndrome are caused by impaired venous blood flow in the SVC system. The clinical picture is affected by the rate of development of cava syndrome, as well as the degree of blood flow disturbance. Depending on these indicators, SVC may develop slowly (with compression or invasion of the vessel) or quickly (with blockage of the SVC by blood clots).

The patient's upper body swells, the skin of the face and neck turns blue

The SVCS clinic includes swelling of the face, neck, arms, upper half of the torso due to the expansion of superficial venous vessels, as well as blueness of the skin and mucous membranes. In addition, patients complain of shortness of breath, feeling short of breath, hoarseness, difficulty swallowing, coughing fits, and chest pain. Strengthening of these signs is observed when the patient assumes a horizontal position, so they are forced to be in a semi-sitting position. Because of the swelling of the larynx, stridor appears (whistling noisy breathing, a rough and hoarse voice).

Often SVCS is accompanied by nasal, pulmonary, gastric, intestinal hemorrhages due to increased venous pressure and rupture of thinned vessels. Violated from the cranium provokes a headache, noises, drowsiness, convulsions, fainting. The functionality of the oculomotor or auditory nerves is impaired, double vision develops, protrusion of the eyeballs, excessive release of lacrimal fluid, and various hearing disorders.

Diagnostic Measures

Physical diagnosis will help identify the characteristic symptoms of SVCS. As a result of a visual examination, the doctor can easily determine the expansion of the veins in the neck and chest, the blue of the face, and the swelling of the upper torso. If SVCS is suspected, a chest X-ray in two projections is prescribed. If necessary, conduct a computer, magnetic resonance imaging. To identify the location and severity of SVC obstruction, phlebography is prescribed.

If SVCS is suspected, x-rays are ordered

To diagnose blockage of a venous vessel by a thrombus or its compression from the outside, ultrasound Dopplerography of the carotid and supraclavicular veins is performed.

The ophthalmologist will determine the eye disorders characteristic of SVCS:

tortuous and dilated veins of the fundus;
swelling of the peripapillary area;
non-inflammatory edema of the optic nerve;
increased intraocular fluid pressure.

To determine the causes of SVCS and confirm the morphological (tumor genesis) diagnosis, bronchoscopy is performed with tissue sampling, as well as bronchial sputum, which are examined for the presence of atypical cells. Microscopic examinations of washing waters from the deep sections of the bronchial tree are also carried out. In addition, lymph node cells are taken and sternal puncture is performed.

If necessary, the doctor prescribes additional studies:

videothoracoscopy;
mediastinoscopy;
mediastinotomy, etc.

Differential diagnosis of SVCS is carried out with functional heart failure. In the pathology of the superior vena cava, there is no peripheral edema, accumulation of transudate (non-inflammatory fluid) in the pleural cavity, and abdominal dropsy.

Treatment Methods

Symptomatic treatment of pathology is carried out in order to increase the functional reserves of the body. The patient must follow a low-salt diet, he is prescribed oxygen inhalations, diuretics and glucocorticoid drugs. After the doctor establishes the causes of the development of SVCS, pathogenetic treatment is carried out.

If the disease provoked lung cancer, lymphoma (oncological damage to the lymphatic tissues), Hodzhikin's disease, metastases, polychemotherapy and radiation therapy are prescribed. If SVCS is caused by blockage of the superior vena cava with blood clots, then thrombolytic treatment is performed, an operation to remove the clot. And sometimes it is necessary to remove a portion of the vein, which is replaced with a homograft.

Treat the underlying disease to eliminate the symptoms of SVCS

With extravasal compression of the superior vena cava, surgical intervention is also indispensable. The surgeon may remove a mediastinal tumor or cyst, mediastinal lymphoma, etc. If for some reason surgical intervention is contraindicated, then a palliative operation is prescribed, which improves venous outflow.

The prognosis of SVC syndrome depends on the primary disease and the possibility of surgical intervention. After the elimination of the underlying causes, the signs of the syndrome of the superior vena cava disappear. In the acute course of kava syndrome, the likelihood of a quick death of the patient increases. If SVCS is caused by advanced cancer, then the prognosis is poor. That is why it is important to identify the pathology in time and treat it.

Kava syndrome, or superior vena cava syndrome, is a complex of specific signs in case of impaired blood circulation in the upper body. Characteristic symptoms include swelling of the neck, cyanosis of the skin, and sudden dilation of the veins. When these symptoms appear, emergency medical attention is needed.

Kava syndrome is often a concomitant symptom of oncological processes affecting the circulatory and pulmonary systems. Pathology can occur in people of different ages and genders. The syndrome in a few percent of cases is diagnosed in pregnant women and children.

Description of the disease and its complications

The superior vena cava is located in the inner space of the middle part of the chest cavity. It is surrounded by other tissues: the sternum wall, trachea, bronchi, aorta, lymph nodes. Its function: ensuring the outflow of blood from the lungs, head, upper body.

The syndrome of the superior vena cava is a complex of specific signs in case of impaired blood circulation of the upper body.

Superior vena cava syndrome is a violation of normal blood circulation in the upper body and head. This vessel can be compressed, change its structure in the course of many pathological processes. As a result, the outflow of blood from the arms, hands, face, head and neck is disturbed. The blood stagnates.

With the syndrome of the superior vena cava, the danger is high blood pressure. In severe cases, it is 200-250 units per systole, which is life-threatening. The most susceptible to the syndrome are men aged 30 to 60 years.

If left untreated, the patient may experience the following complications:

Various bleeding, which is diagnosed mainly in the upper body. The patient will be disturbed by the discharge of blood from the nose, eyes, cough may be with bloody streaks.
Blood stasis can cause thrombosis of the sagittal sinus.
Violation of the outflow of blood from the head causes swelling of the brain, severe headaches, increased intracranial pressure.
The most dangerous consequence of the syndrome is hemorrhagic stroke. The outpouring of blood into the cranial cavity is very dangerous, in half of the cases, patients experience paralysis, muscle paresis. Often there is a lethal outcome.

The most dangerous consequence of the syndrome is hemorrhagic stroke.

Clinical picture

Thrombosis causes dysfunction of the oculomotor or auditory nerves. It can develop quickly or gradually. In the second case, collaterals, that is, alternative ways of outflow of blood, have time to form. At the initial stage, the disease is almost asymptomatic. If the process of thrombus formation develops quickly, the pathology will be difficult. The syndrome develops within 10-20 days.

A forced posture during rest, sleep is a semi-lying position. Sleep at night becomes impossible without the use of sleeping pills.

Causes of the syndrome

Common causes of the development of the syndrome are an unhealthy lifestyle and bad habits, which as a result lead to impaired blood circulation. Less commonly, the development of kavasidroma is provoked by malignant neoplasms:

blood cancer;
brain sarcoma;
oncological processes in the pelvic organs.

Cancer of the blood can cause this syndrome

The development of the syndrome is often associated with the formation of multiple metastases that penetrate the vena cava. Sometimes the syndrome can occur due to cancer of the lung, pleura, thyroid gland, or as a consequence of post-radiation fibrosis.

Sometimes pathology develops as a result of prolonged catheterization. This provokes the appearance of sclerosis or thrombosis. The occurrence of the syndrome of the superior vena cava in children is more often associated with prolonged catheterization of the vena cava in oncology.

Superior vena cava syndrome sometimes provokes an increased volume of circulating blood. In pregnant women, it becomes the result of venous stasis. The uterus in the later stages presses on the diaphragm and the great vena cava. A decrease in the level of oxygen has a bad effect on the organs of a woman, the development of the fetus slows down. In the last trimester, it is provoked by prolonged lying on the back.

Symptoms

As mentioned earlier, few patients pay attention to the symptoms, especially in the early stages of the disease does not have obvious clinical signs. Sometimes there is an increase in blood pressure, which is often attributed to nervous tension.

In the syndrome of the superior vena cava, the clinical picture is complemented by characteristic signs:

the neck becomes swollen;
swelling of the veins is observed on the face, neck, forehead;

Swelling in the neck indicates the presence of pathology

the face becomes swollen, small capillaries burst under the skin;
the skin of the face, hands, neck acquires a characteristic blue tint, due to a violation of the outflow of venous blood.

Any of the observed symptoms requires urgent medical attention. Call emergency services if symptoms develop very quickly.

With the slow development of the syndrome of the superior vena cava, a person is concerned about:

Respiratory disorders. It can be shortness of breath, even at rest, a feeling of lack of air, inability to breathe.
Swallowing disorder. The patient cannot eat or drink.
There is a cough that gets worse over time. The cough itself is dry, but may be streaked with blood.
Forgetfulness, dizziness, headaches, cramps of the lower and upper extremities.

The severity of symptoms depends on the rate of development and the number of collaterals formed.

Diagnostics

To begin with, the patient should contact a general practitioner, a cardiologist and a neuropathologist for a correct diagnosis. The syndrome is diagnosed using a survey, history taking and instrumental research methods.

One of the types of diagnostics is magnetic resonance therapy.

The patient may be given:

chest X-ray in 2 projections;
vascular angiography;
CT scan;
magnetic resonance therapy.

The last two methods are the most informative. Often, consultation with an ophthalmologist, ENT, and, if necessary, an oncologist is required.

Bronchoscopy, biopsy of lung tissue and lymph nodes, thoracoscopy (examination of the pleural cavity) will help in more detail in the diagnosis of the syndrome of the superior vena cava. Such an examination reveals the degree of obstruction of the vena cava.

Treatment

With the secondary syndrome of the superior vena cava, treatment is symptomatic. It is used along with the main therapy. The goal of adjunctive treatment is to maintain the body's internal reserves. Conservative therapy includes:

oxygen inhalations;
diuretics;
cortecosteroids.

Diuretics in the treatment of this syndrome

In severe cases of the syndrome of the superior vena cava, surgery will be required. The patient may be given:

thrombectomy;
resection of the damaged area of the vena cava (a homo-implant is installed in its place);
shunting (bypass ways of outflow of blood);
removal of mediastinal cysts;
stenting of the great vena cava.

With prolonged catheterization, balloon dilatation of the damaged section will be required.

Prognosis for superior vena cava symptom

With secondary superior vena cava syndrome, good prognosis is impossible without successful primary therapy. Only the removal of the root cause will help stop the pathological process. The prognosis is unfavorable with an oncological factor provoking the syndrome, or with its acute course. During pregnancy, the disease provokes fetal hypoxia.

conclusions

Superior vena cava syndrome is a change caused by long-term compression of the vena cava or its obstruction. Its causes may be different, but a successful cure is possible only when the root cause is completely cured.

The acute development of the syndrome leads to the death of a person. At the first symptoms, the patient urgently needs medical attention.

- this is a symptom complex that develops as a result of circulatory disorders in the system of the superior vena cava and difficulty in the outflow of venous blood from the upper parts of the body. The classic signs of superior vena cava syndrome are: cyanosis; puffiness of the head, neck, upper limbs, upper half of the chest; expansion of the saphenous veins; shortness of breath, hoarseness, cough, etc. Often cerebral, ocular, hemorrhagic manifestations develop. The diagnostic algorithm may include chest radiography, venocavography, CT and MRI of the chest, ultrasound, mediastinoscopy, thoracoscopy with biopsy. With the syndrome, endovascular balloon angioplasty and stenting, thrombectomy, resection of the SVC, bypass shunting, palliative removal of the tumor in order to decompress the mediastinum can be undertaken.

General information

Under the syndrome of the superior vena cava (SVCS), or cava syndrome, is understood a secondary pathological condition that complicates many diseases associated with damage to the mediastinal organs. Cava syndrome is based on extravasal compression or thrombosis of the superior vena cava, which disrupts the outflow of venous blood from the head, shoulder girdle, and upper half of the body, which can lead to life-threatening complications. The syndrome of the superior vena cava is 3-4 times more likely to develop in male patients aged 30-60 years. In clinical practice, specialists in the field of thoracic surgery and pulmonology, oncology, cardiac surgery, and phlebology have to deal with the syndrome of the superior vena cava.

The superior vena cava (SVC) is located in the middle mediastinum. It is a thin-walled vessel surrounded by dense structures - the chest wall, aorta, trachea, bronchi, a chain of lymph nodes. Features of the structure and topography of the SVC, as well as physiologically low venous pressure, cause an easy onset of obstruction of the main vessel. The SVC drains blood from the head, neck, upper shoulder girdle, and upper chest. The superior vena cava has a system of anastomoses that perform a compensatory function in violation of the patency of the SVC. However, venous collaterals cannot completely replace the SVC. With the syndrome of the superior vena cava, the pressure in its pool can reach 200-500 mm of water. Art.

Causes of SVTS

The following pathological processes can contribute to the development of the syndrome of the superior vena cava: extravasal compression of the SVC, tumor invasion of the SVC wall, or thrombosis. In 80-90% of cases, the immediate causes of kava syndrome are lung cancer, mainly right-sided localization (small cell, squamous, adenocarcinoma); Hodgkin's disease, lymphomas; metastases of breast cancer, prostate cancer and testicular cancer to the mediastinum; sarcoma etc.

In other cases, benign tumors of the mediastinum (cysts, thymomas), fibrous mediastinitis, aortic aneurysm, constrictive pericarditis, infectious lesions (syphilis, tuberculosis, histoplasmosis), retrosternal goiter can lead to compression of the SVC. The syndrome of the superior vena cava may be due to thrombosis of the SVC, which develops against the background of prolonged catheterization of the vein with a central venous catheter or the presence of pacemaker electrodes in it.

Symptoms of SVCS

The clinical manifestations of the syndrome of the superior vena cava are due to an increase in venous pressure in the vessels, the blood from which normally flows through the SVC or innominate veins. The severity of manifestations is influenced by the rate of development of the syndrome of the superior vena cava, the level and degree of circulatory disorders, the adequacy of the collateral venous outflow. Depending on this, the clinical course of the syndrome of the superior vena cava can be slowly progressive (with compression and invasion of the SVC) or acute (with thrombosis of the SVC).

The classic triad of superior vena cava syndrome includes edema, cyanosis, and dilated superficial veins in the face, neck, upper extremities, and upper torso. Patients may experience shortness of breath at rest, asthma attacks, hoarseness, dysphagia, cough, chest pain. These symptoms are aggravated in the supine position, so patients are forced to take a semi-sitting position in bed. In a third of cases, stridor is noted, caused by swelling of the larynx and threatening airway obstruction.

Complications

Often, with superior vena cava syndrome, nasal, pulmonary, and esophageal bleedings develop, caused by venous hypertension and rupture of thinned vessel walls.

Violation of the venous outflow from the cranial cavity leads to the development of cerebral symptoms:

headache
noise in the head
drowsiness
confusion and loss of consciousness.

Due to impaired function of the oculomotor and auditory nerves, the following may develop:

diplopia
bilateral exophthalmos
lacrimation
eye fatigue
decreased visual acuity
auditory hallucinations

Diagnostics

Physical examination of a patient with superior vena cava syndrome reveals swelling of the veins of the neck, an expanded network of subcutaneous venous vessels on the chest, plethora or cyanosis of the face, and edema of the upper half of the body. If superior vena cava syndrome is suspected, all patients are shown an x-ray examination - chest x-ray in two projections, tomography (computer, spiral, magnetic resonance). In some cases, to determine the localization and severity of venous obstruction, phlebography (venocavagraphy) is used.

CT scan of the chest. A sharp narrowing of the lumen of the superior vena cava due to the germination of a mediastinal tumor into it with a pronounced difficulty in the outflow of venous blood from the head and upper limbs

For the purpose of differential diagnosis of SVC thrombosis and obstruction from the outside, ultrasound of the carotid and supraclavicular veins is indicated. Examination of the fundus by an ophthalmologist reveals tortuosity and dilation of the retinal veins, edema of the peripapillary region, congestive optic disc. When measuring intraocular pressure, there may be a significant increase.

Bronchoscopy with biopsy and sputum sampling may be required to determine the causes of the superior vena cava syndrome and verify the morphological diagnosis; sputum analysis for atypical cells, cytological examination of bronchial washings, biopsy of the lymph node (scaling biopsy), sternal puncture with myelogram examination. If necessary, diagnostic thoracoscopy, mediastinoscopy, mediastinotomy, or parasternal thoracotomy may be performed to explore and biopsy the mediastinum.

Differential diagnosis of cava syndrome is carried out with congestive heart failure: in the syndrome of the superior vena cava, there are no peripheral edema, hydrothorax, ascites.

Treatment of SVCS

Symptomatic treatment of the syndrome of the superior vena cava is aimed at increasing the functional reserves of the body. It includes the appointment of a low-salt diet, oxygen inhalations, diuretics, glucocorticoids. After establishing the cause that caused the development of the syndrome of the superior vena cava, they proceed to pathogenetic treatment.

So, with the syndrome of the superior vena cava, caused by lung cancer, lymphoma, lymphogranulomatosis, metastases of tumors of other localizations, polychemotherapy and radiation therapy are performed. If the development of the syndrome of the superior vena cava is caused by thrombosis of the SVC, thrombolytic therapy is prescribed, thrombectomy is performed, in some cases, resection of the segment of the superior vena cava with replacement of the resected area with a venous homograft.

With extravasal compression of the SVC, radical interventions may include extended removal of a mediastinal tumor, removal of mediastinal lymphoma, thoracoscopic removal of a benign tumor of the mediastinum, removal of a mediastinal cyst, etc. If it is impossible to perform a radical operation, they resort to various palliative surgical interventions aimed at improving venous outflow: removal of the tumor mediastinum for decompression, bypass, percutaneous endovascular balloon angioplasty, and stenting of the superior vena cava.

Forecast

The long-term results of the treatment of the superior vena cava syndrome depend primarily on the underlying disease and the possibilities of its radical treatment. Elimination of the causes leads to the relief of manifestations of kava syndrome. The acute course of the syndrome of the superior vena cava can cause rapid death of the patient. With the syndrome of the superior vena cava, caused by a running oncological process, the prognosis is unfavorable.

Medicine is not considered an exact science, and it is based on many assumptions and probabilities, but not facts. Inferior vena cava syndrome is a rather rare occurrence in medical practice. It can occur in men and women at any age, more often in the elderly. Pregnant women are in the first place at risk. In this case, the condition of the pregnant woman is characterized by polyhydramnios, venous and arterial hypotension. Most often, the fetus is large. When the vein is compressed, the blood flow to the liver and kidneys, the uterus worsens, which negatively affects the development of the child. The condition can result in stratification of the placental tissue, and this is a huge risk of developing varicose veins, thrombophlebitis in the lower extremities. If childbirth is carried out by caesarean section, then the likelihood of collapse is high.

The concept of inferior vena cava

The inferior vena cava is a wide vessel. It is formed by the fusion of the left and right iliac veins located in the abdominal cavity. The vein is located at the level of the lumbar, between the 5th and 4th vertebrae. It passes through the diaphragm and enters the right atrium. The vein collects blood that passes through neighboring veins and delivers it to the heart muscle.

If a person is healthy, then the vein works synchronously with the respiratory process, that is, it expands on exhalation, and contracts on inspiration. This is its main difference from the aorta.

The main purpose of the inferior vena cava is to collect venous blood from the lower extremities.

Why Problems Occur

According to statistics, approximately 80% of all pregnant women experience vein compression after 25 weeks, to a greater or lesser extent.

If there is no inferior vena cava syndrome, then the pressure in the vein at a sufficiently low level is a normal physiological state. However, problems in the tissues that surround the vein can compromise its integrity and drastically change blood flow. For a while, the body is able to cope by finding alternative ways for blood to flow. But if the pressure in the vein rises above 200 mm, then a crisis invariably sets in. At such moments, without urgent medical care, everything can end in death. Therefore, you should know the inferior vena cava in order to call an ambulance in time if a crisis begins in the patient himself or in someone close.

Clinical picture

The first thing you need to pay attention to is swelling, which can be on the face, neck, in the larynx. This symptom is observed in 2/3 of patients. Shortness of breath, coughing, hoarseness of voice, even at rest and lying down, may disturb, and this is a huge risk of airway obstruction.

Also, inferior vena cava syndrome may be accompanied by:

Pain in the groin and abdomen;

swelling of the lower extremities;

Swelling on the buttocks and genitals;

Varicose veins of small vessels in the thigh area;

impotence;

high body temperature;

Brittle nails and hair loss;

Constant pallor;

Leg problems - it is difficult for the patient to move even for short distances;

fragility of bones;

high blood pressure;

Silicosis;

Purulent mediastinitis;

Fibrosis.

Diagnostics

Naturally, only one compression of the inferior vena cava is not determined. A thorough diagnosis is required.

First of all, the doctor collects a complete history, conducts an examination. A lot can "tell" the state of the veins in the neck and upper limbs, as a rule, they are dilated. Physical examination also gives an idea: the patient has cyanosis or plethora, whether the venous networks in the chest area are expanded, whether there is swelling, especially in the upper parts of the body.

X-ray examination and phlebography are also prescribed. X-ray examination can be carried out with the help of a contrast agent. Be sure to carry out magnetic resonance and computer topography, possibly spiral.

In some cases, the diagnosis of inferior vena cava syndrome is accompanied by an in-depth examination by an ophthalmologist. The purpose of the diagnosis is to identify, if present, retinal vein dilatation, possible edema of the peripapillary region, to determine whether the intraocular pressure has increased, whether there is stagnation in the optic nerve.

For the full picture, you may need:

Bronchoscopy;

Biopsy of sputum and lymph nodes;

Sternal puncture;

Mediastinoscopy.

Therapeutic activities

Treatment of inferior vena cava syndrome is symptomatic. This pathology is still a concomitant disease, and first of all it is required to cure the underlying disease that caused the syndrome.

The main goal of treatment is to activate the internal reserve forces of the body in order to maximize the quality of life of the patient. The first thing that is recommended is a practically salt-free diet and oxygen inhalations. It is possible that drugs from the group of glucocorticosteroids or diuretics will be prescribed.

If the syndrome appeared against the background of the development of a tumor, a completely different approach to treatment.

Surgery is indicated in the following cases:

The syndrome is rapidly progressing;

No collateral circulation;

Blockage of the inferior vena cava.

Surgery does not eliminate problems, but only improves venous outflow.

Syndrome and pregnancy

During the period of gestation, all organs of a woman experience the heaviest load, the volume of circulating blood increases and, as a result, stagnation appears. The uterus increases and compresses not only the surrounding organs, but also the vessels. With the syndrome of the inferior vena cava in pregnant women, treatment should be carried out with extreme caution.

Problems begin with the fact that it is very difficult for a woman to lie on her back, usually this condition begins from the 25th week of gestation. There is a slight dizziness, weakness, periodically there is not enough air. Blood pressure usually decreases. Very rarely, a pregnant woman may lose consciousness.

Naturally, we are not talking about cardinal therapeutic measures during pregnancy, but some rules will still help to transfer the syndrome more easily:

You will have to abandon all exercises that are carried out in a supine position, on your back;

Also, do not sleep on your back;

Nutrition should be adjusted to reduce salt intake;

It is necessary to reduce the amount of fluid consumed;

To improve the condition, it is better to walk more, in this case, the muscles on the lower leg contract, and this process stimulates the movement of venous blood upwards;

Forecast and prevention

Doctors are optimistic about patients with the syndrome if it is detected at an early stage. The only condition is constant monitoring of the state of health and compliance by the patient with all the recommendations of the attending physician.

As a preventive measure is the prevention of cardiovascular disease. If there are problems with blood clotting, then the pathology should also be under constant medical supervision, since such patients are at risk. Even the thought of self-treatment should be abandoned.