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Surgical Treatment
Surgical bypass is an additional alternative to
relieve SVCS. The surgical option is usually recom-
mended to patients with benign disease and to only a
few patients with malignancy. Patients selected for
surgery should have the venographic sign of total
superior vena cava obstruction associated with throm-
bosis of caval branches and distension of the veins of
the upper extremity. Surgery in cases of fibrosing
mediastinitis can be extremely complicated. Because
of the gradual onset of this disorder, the collateral cir-
culation is extensive and serious bleeding can occur if
any of these vessels is transected. In addition, because
of the associated venous hypertension, all the collater-
al circulation is under high pressure.
The advantages of surgery are the expeditious and
definitive removal of the obstruction and the conve-
nience of direct tissue diagnosis. Venous thrombecto-
my may be indicated in select patients with catheter-
induced thrombosis of the superior vena cava when
the foreign material can be removed in addition to
the obstructing catheter. However, most data after sur-
gical bypass are obtained from patients soon after
surgery. Long-term results after surgical bypass are
lacking, chiefly because most of these patients have a
malignancy and their life expectancy is short.
1, 11–17
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