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

Contrast venography. 

The extent and site of ob-

struction as well as the nature of obstruction must be

identified when SVCS is diagnosed. Identification of

these features may be achieved by a number of radio-

logic imaging studies. Contrast venography can provide

information regarding the patency of the superior vena

cava, the degree of superior vena cava obstruction, and

the differentiation between intrinsic and extrinsic causi-

tive factors responsible for the obstruction. Contrast

venography also provides assessment of collateral vessel

formation, the degree of venous distension of the neck

and arms, measurement of actual venous pressure, and

the presence of the internal jugular vein reflux.

Contrast venography is essential prior to planning

any surgical bypass operation. Surgical bypass opera-

tions are easier to accomplish when the brachiocephal-

ic veins are not involved. However, if all the intra-

thoracic veins are obstructed, extrathoracic bypass oper-

ations can be undertaken, but the operation is more

technically difficult and the results are less favorable.

4

Contrast venography is also very helpful in docu-

menting obstructions caused by thrombus formation.

When thrombosis is present, treatment with fibrinolyt-

ic agents (eg, urokinase, streptokinase) is pursued and

repeat venography can be used to evaluate treatment

efficacy. In the rare cases in which fresh thrombosis is

detected in the superior vena cava, thromboembolec-

tomy may be an alternate method of treatment.