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Ann Thorac Surg 1986;41:158-163
© 1986 The Society of Thoracic Surgeons

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Articles

The Role of Venography and Surgery in the Management of Patients with Superior Vena Cava Obstruction

Department of Radiology and the Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa, Iowa City, IA

Accepted for publication March 29, 1985.

^* Address reprint requests to Dr. Stanford, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242

Venacavography proved to be an excellent guide for the design of patient management programs. Type 1 patients with incomplete obstruction of the superior vena cava (SVC) are best managed by irradiation and chemotherapy regimens and usually do not require operation to bypass the SVC. Types II and IV patients are treated by operation when symptoms of airway obstruction or cerebral venous hypertension are present. Type III patients should be considered for SVC bypass as an initial therapeutic intervention. This group is more likely to have cerebral or airway symptoms and would benefit most from the bypass operation. In terms of operative considerations, type III patients are ideal for operation because the left brachiocephalic vein is usually available for bypass. Type IV patients may also be considered, but operation is more difficult and may require venous thrombectomy or extension of the bypass graft above the thoracic inlet to obtain head and neck decompression.

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