Superior Vena Cava Syndrome John H Rundback MD
Superior Vena Cava Syndrome John H. Rundback MD FSVM FAHA FSIR Interventional Institute at Holy Name Hospital Columbia University College of Physicians & Surgeons
DISCLOSURES John H. Rundback, MD Consulting Fees – ev 3, Inc. , Medtronic Cardio. Vascular, Inc. , Boston Scientific Corporation Honoraria – Medtronic Cardio. Vascular, Inc. , Boston Scientific Corporation Grants/Contracted Research – DSMC for VIVA (Abbott Trial), ev 3, Inc. , Abbott Vascular, C. R. Bard, Inc. , Atrium Medical Corporation, W. L. Gore & Associates, Inc. , Cordis, a Johnson & Johnson company, Terumo Medical Corporation
SVC Syndrome �Occlusion or stenosis of the central veins bilaterally due to benign or malignant causes that impedes upper extremity, facial, and cerebral venous drainage resulting in signs and symptoms of venous hypertension.
Causes Benign (20 -40%) Central Venous Catheters Pacemakers Mediastinitis Radiation Infections • TB, Silicosis, Histoplasmosis Malignant (60 -80%) Lymphoma [NHL] Primary Lung ca Renal Cell Ca Other malignancies 50 -60% of subclavian HD catheters results in unilateral central venous stenosis or occlusion
J Thorac Oncol. 2008 Aug; 3(8): 811 -4.
Clinical Grading of SVC Syndrome Grade Description Incidence Findings 0 Asx 10% Radiographic 1 Mild 25% Edema 2 Moderate 50% Fnctional Impairment 3 Severe 10% Mild-mod cerebral/laryngeal edema, ↓ cardiac reserve 4 Life. Threatening 5% Significant cerebral/laryngeal/cardiac disturbance 5 Fatal <1% death J Thorac Oncol. 2008 Aug; 3(8): 811 -4
Treatment �Benign anticoagulate 1 -3 (pacemakers) stent grade 4 -5 �Malignant, grade 1 -3 treat underlying dz radiation persistent sx stent brain mets stent airway cxs stent, ? thrombolysis �Malignant, grade 4 -5 emergency stent
“Sharp” Recanalization
Pacing Clin Electrophysiol. 2009 Dec 28. Managing Superior Vena Cava Syndrome as a Complication of Pacemaker Implantation: A Pooled Analysis of Clinical Practice.
J Vasc Surg. 2008 Feb; 47(2): 372 -80 MAYO CLINIC n=70 42 open 28 stents
30 days
surgery 1 o patency same at 1, 2, 3 yrs stent endovascular
2009 Feb PRIMARY STENTING
2009 Feb SECONDARY STENTING
Conclusion �Use of stents is first line therapy for severely symptomatic SVC syndrome �Thrombolysis indicated for SVC thrombosis �Major complications rare �Recurrence in approx 20% of cases �Primary stenting appears to be best treatment modality for malignant SVC syndrome
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