Understand the pathophysiology and etiology of SVC syndrome Learn about the clinical presentation and imaging evaluation of SVC syndrome Illustrate the various management options Knowledge about the principle endovascular techniques To familiarize with the technique, outcomes, complications of endovascular management

Superior vena cava (SVC) syndrome is a constellation of findings due to SVC obstruction secondary to intrinsic or extrinsic causes. William Hunter first described the syndrome in 1757 in a patient with syphilitic aortic aneurysm [1]. Role of surgery being limited; endovascular management is increasingly used. Etiology [2] : Malignancy (80%)-primary lung (bronchogenic carcinoma mostly small cell carcinoma)and mediastinal tumors(mostly non hodgkins lymohoma), hodgkin disease, metastatic cancers,primary leiomyosarcomas of the mediastinal vessels, and plasmocytomas Mediastinal fibrosis Vascular diseases, such asaortic aneurysm, vasculitis, andarteriovenous fistulas Infections,...

Technique of endovascular management [5]: The procedure is carried out under local anaesthesia with aseptic precautions. The venous approach in majority of the situations involves puncture of the right common femoral vein. This is followed by the placement of a 7-French introducer sheath according to the Seldinger technique. In addition to femoral access, additional upper extremity venous access is necessary in about 20% of the cases. Venography of the SVC and brachiocephalic veins is performed using a 5-French pigtail catheter to visualize the SVC lesion....

Endovascular therapy is now considered appropriate first-line treatment for SVC syndrome, regardless of benign or malignant etiology. Thrombolysis, PTA, and stenting are often utilized in combination approaches for effective and rapid relief of symptoms Provides immediate and significant relief of symptoms (within 24-72 hrs) and non- interference with subsequent antitumor treatments. It is a minimally invasive option with high efficacy and lower morbidity rates when compared to surgical therapy. Outcomes and complications compare very favorably with standard therapies such as chemotherapy and radiotherapy .

Hunter W. The history of an aneurysm of the aorta with some remarks on aneurysms in general.Med Obs Enq. 1757. 1:323-357. Nieto AF, Doty DB. Superior vena cava obstruction: clinical syndrome, etiology, and treatment.Curr Probl Cancer. 1986 Sep. 10(9):441-84. Jonathan D. Grant, Bs; Julie S. Lee, Md; Edward W. Lee, Md, Phd; And Stephen T. Kee, Md. Superior Vena Cava Syndrome An Update On Causes And Treatments. Cover Story Endovascular Today I July 2009 Janessa Laskin et al. Superior vena cava syndrome. Abeloff's Clinical Oncology...