ABSTRACT
This chapter reviews the etiology of superior vena cava (SVC) syndrome and discuss the clinical presentation, pre-operative evaluation, and surgical/endovascular treatment of these patients. Obstruction of the SVC or innominate veins occurs most frequently in patients with metastatic malignant disease. The most frequent etiology of SVC syndrome is metastatic malignant disease. Benign causes of SVC syndrome include fibrosing mediastinitis or granulomatous fungal diseases such as histoplasmosis. The most frequent symptom of SVC syndrome is the feeling of fullness in the head and neck, which is more severe when the patient bends over or lies flat in bed. Symptoms of SVC syndrome associated with metastatic malignant disease frequently improve following irradiation or chemotherapy, and these constituted the mainstay of treatment in these patients before endovascular treatments became available. Surgical reconstruction of the SVC has also been performed in patients with different types and stages of malignant disease.
