Uperior vena cava syndrome (svcs) was first described in l757 in a patient with a syphilitic



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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.

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