Lung cancer of the superior vena cava. What causes the syndrome of compression of the superior vena cava - define

The syndrome of the inferior vena cava develops due to blockage of this large vessel and is a severe form of venous obstruction. This concept includes a number of clinical manifestations: changes in venous hemodynamics, dysfunction of the abdominal organs, signs of chronic venous insufficiency of the lower extremities. Depending on the place of blockage, the lower, middle and high form of chronic occlusion of the inferior vena cava is distinguished.

• Inferior obstruction to the level of the renal veins.
• Average - the level of the renal veins
• Superior above the renal segment (Budd-Chiari syndrome)

The inferior vena cava (IVC) is located right side from the aorta; then she passes behind small intestine and pancreas; penetrates through the diaphragm into the middle section of the chest cavity and into the cavity of the right atrium. Through the circulatory system of the inferior vena cava passes 70% of all venous blood. Therefore, impaired patency in this large vessel leads to systemic hemodynamic disorders and deterioration of venous outflow from the lower extremities.

Classification

There are two forms of IVC syndrome:

• Acute thrombosis of the inferior vena cava

It develops with an injury to the IVC or thrombosis of a previously installed cava filter. Sometimes it can occur against the background of compression of the vena cava by the tumor and an increase in the degree of blood clotting. It is characterized by sudden swelling of both lower extremities, may be accompanied by pain in the legs and swelling of the saphenous veins. In acute obstruction of the IVC, circulatory shock may develop due to a sudden decrease in venous return ("empty" ejection from the heart).

• Chronic obstruction of the inferior vena cava

It develops against the background of the syndrome of compression of the IVC by a tumor or cicatricial changes after the installed cava filter. Chronic occlusion is accompanied by the slow development of chronic venous insufficiency, the appearance of secondary varicose veins on the abdominal wall and lower extremities. Over time, development is possible trophic ulcers on both legs.

Causes and risk factors

Inferior vena cava syndrome can be caused by diseases such as:

• Ileofemoral phlebothrombosis (often develops in patients with pelvic pathology and in pregnant women),
• Acute thrombophlebitis of the veins of the lower extremities.
• Syndrome of compression of the inferior vena cava by a tumor of the abdominal cavity, pancreas, kidney and genitourinary organs.
• Budd-Chiari syndrome - blockage of the hepatic segment of the IVC.
• Ormond's disease is a rare disease associated with overgrowth connective tissue in the retroperitoneal space, accompanied by compression of the organs of the urinary system, as well as large veins, not excluding the inferior vena cava.
• Pregnancy is a risk factor for venous thrombosis, especially with congenital predisposition to thrombophilia. Pregnant women with multiple pregnancies and a history of thrombophlebitis are at particular risk.
• addiction with intravenous administration drugs.
• Operations on the organs of the abdominal cavity and retroperitoneal space.
• Operations on the inferior vena cava, including the installation of a cava filter.

Symptoms of the disease

The symptoms of IVC syndrome, as well as the course of the disease, depend on the level of blockage. The most characteristic of them are the symptoms inherent in chronic venous insufficiency of the lower extremities:

• Pain that extends to the leg, back, groin, buttocks and abdomen radiates to the left side.
• Increasing the circumference of the thigh and lower leg.
• Numbness lower limb.
• Edema of the genitals and abdominal wall.
• Trophic ulcers on the legs.
• There is a visible expansion of the veins above the pubis and on the abdomen.

Symptoms of obstruction of the renal segment of the IVC:

• Violation of the functions of the gastrointestinal tract (vomiting, diarrhea, etc.)
• Nephrotic syndrome - impaired kidney function
• Difficulty urinating and defecation.
• Bleeding from the anus

Forecast

With the acute development of the clinical picture of occlusion of the inferior vena cava, the prognosis for life is unfavorable. It is necessary to count on the effectiveness of treatment with thrombolysis or thrombectomy from the inferior vena cava. In the case of restoration of blood flow, it is necessary to observe a phlebologist for a long time and look for the causes of the development of the disease in order to prevent a relapse.

Chronic occlusion of the IVC occurs with a gradual deterioration in venous outflow. With successful recanalization of the inferior vena cava, the reverse development of symptoms of chronic venous insufficiency is possible.

Advantages of treatment in the clinic

Effective thrombolysis under X-ray control

Installing removable cava filters

Angioplasty and stenting of the inferior vena cava

Diagnostics

The syndrome of the inferior vena cava usually does not cause difficulty in diagnosis. Knowledge of the clinical picture by an experienced physician makes it possible to suspect occlusion of the inferior vena cava. The diagnostic algorithm is based on the clinical picture:

• Bilateral symmetrical edema of both legs
• Expansion of the saphenous veins in the groin and abdomen
• Accumulation of fluid in the abdomen.

Differential Diagnosis

It is necessary to distinguish between edema associated with chronic heart failure and ascites associated with cirrhosis of the liver. Heart failure is characterized by other symptoms, such as shortness of breath, low exercise tolerance. History of heart attacks or atrial fibrillation. For cirrhosis of the liver, the accumulation of fluid in the abdomen is more characteristic, while the legs remain of the usual volume. Jaundice and dilation of the saphenous veins of the abdomen are characteristic of cirrhosis, while large varicose veins of the anterior abdominal wall are more common in the inferior vena cava syndrome, and the treatment of these two diseases is different.

Deep vein ultrasound

With state of the art equipment ultrasound diagnostics it is possible to reliably assess the patency of the inferior vena cava and iliac veins. Depending on the degree of damage to the vessel, narrowing or complete blockage of the inferior vena cava may be observed. Ultrasound can help determine the patency of the renal veins and the hepatic segment. The diagnostic algorithm includes the study of superficial and deep veins of the lower extremities, the system of veins of the small pelvis. Often, ultrasound can reveal the pathology that led to the development of venous thrombosis. Using ultrasound, it is possible to assess the patency of the cava filter in the IVC and the correctness of its installation in relation to the renal veins. Data ultrasound usually sufficient to warrant conservative treatment.

If surgical treatment is contemplated, accurate visualization of the affected venous segments is necessary. modern medicine has great potential for this.

MRI - phlebography

This is a non-contrast study of deep veins using a magnetic resonance imaging scanner. In a strong magnetic field, the protons are deflected and then, returning to their normal position, emit an electromagnetic signal. Since the body consists mainly of water, the study of proton energy makes it possible to reveal the structure of organs and tissues. With the help of MRI, it is possible to assess the patency of the deep veins of the lower extremities and the abdominal cavity, to identify the condition of the surrounding internal organs. The study allows not only to detect vascular pathology, but also its causes (compression by tumors of the small pelvis, kidneys and retroperitoneal space).

MSCT - phlebography

This is an x-ray contrast study of deep veins using a CT scanner. Unlike the usual computed tomography phlebography should be performed by specially trained personnel, since the contrast injected into the saphenous veins of the legs must be accurately dosed for better visualization of the problem area.

Phlebography

This is a contrast study performed by injecting contrast directly into the deep veins of the lower extremities to the area of ​​surgical interest. It is used before performing endovascular surgery as the final diagnostic method.

The Innovative Vascular Center owns all the necessary technologies for the treatment of acute and chronic occlusion of the inferior vena cava. Our specialists have successful experience in solving this complex problem.

Acute thrombosis of the inferior vena cava requires treatment in a specialized hospital for vascular surgery. The aim of treatment is to restore the patency of the IVC. This problem is successfully solved with the help of endovascular surgery methods. There are modern thrombolytic drugs and endovascular probes for removing thrombotic masses.

thrombolysis

Dissolution of venous thrombi with special preparations - thrombolytics. These include streptokinase, urokinase, and actilyse. Effective is only the direct injection of a thrombolytic through a catheter into a thrombus with regular monitoring of the patency of the affected segment. Options for thrombolysis can be the use of a special device Angiojet. The thrombolytic solution is fed through a special probe under high pressure, and then the clots are sucked up by a special suction. Another similar device used in our clinic is the Aspirex probe. This is a special spiral suction that gently extracts thrombotic masses. The use of Aspirex in the inferior vena cava is limited due to its large diameter, so catheter thrombolysis is the most acceptable method. Performing thrombolysis is possible only in the first 10 days from the onset of the disease, while the blood clots have not yet healed.

Angioplasty and stenting

The chronic form of IVC syndrome is more difficult to treat. With decompensation of the venous outflow, it becomes necessary to restore the patency of the vessel. Open surgeries associated with the isolation of the IVC and its replacement with a vascular prosthesis are feasible, but very traumatic and ineffective. An artificial vena cava prosthesis often re-thromboses and a complex operation becomes completely useless. With the advent of new composite materials for large-diameter stents, our clinic began to perform endovascular methods for restoring the patency of the vena cava.
Angioplasty and stenting of the IVC is performed by experienced endovascular surgeons of the Innovative Vascular Center. The meaning of the intervention is to restore the patency of the closed segment of the inferior vena cava with a special conductor, a balloon high pressure and installation of a metal frame - a stent.

Conservative therapy

The most common treatment option is conservative therapy with anticoagulants. The anticoagulant warfrin or xarelto are drugs used to treat inferior vena cava syndrome. Detralex or phlebodia are used to improve the outflow of blood from the legs. The main means of conservative treatment is the constant wearing of compression stockings of 2-3 compression classes. They need to be changed every 3 months, as they lose their properties with prolonged wear.

Treatment of symptoms of inferior vena cava syndrome with drugs and compression can reduce chronic venous insufficiency. Given the technical complexity of surgical treatment, conservative methods are predominant in modern medical practice.

Treatment results

The patient was admitted with gangrene of 3 fingers of the right hand against the background of thrombosis of the arteries of the hand and forearm. A complex microsurgical operation to bypass the arteries of the hand followed by intraoperative thrombolysis was performed. It was possible to completely preserve the hand and its function without any amputations.

A case of successful thrombolysis in thrombosis of the left venous femoral-iliac segment is presented. The patient was treated conservatively for 14 days in one of the Moscow hospitals. However, there was a severe venous insufficiency, swelling and cyanosis of the leg. 08/12/2019 received a left leg injury. No bone traumatic injuries were identified. After the injury, she was worried about pain in the region of the left ankle joint when walking. From 09/06/2019 the patient began to notice a feeling of "bursting" in the left leg and foot, swelling of the left lower limb. 09/06/2019 hospitalized in the city hospital. V.V. Veresaev with a diagnosis of left-sided ileofemoral phlebothrombosis. Against the backdrop of ongoing conservative therapy the patient did not notice improvement, soreness and swelling of the left lower limb persisted.

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Endovascular Surgeon

Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment. Specialist in endovascular diagnostic and treatment methods, X-ray endovascular surgeon. Masters all modern views and methods for performing X-ray surgical interventions: arteriography and coronary angiography, revascularization of the coronary arteries (angioplasty and stenting).

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Vascular surgeon

Leading vascular surgeon of the clinic. He owns the methods of operations on the thoracic and abdominal aorta, carotid and vertebral arteries. Priorities in the clinic are operations on the microarteries of the lower leg and foot, transplantation of blood-supplying flaps in case of extensive necrosis and bedsores, hybrid operations on vessels, lymphovenous anastomoses.

The syndrome of the superior vena cava consists of a group of symptoms that develop due to a violation of blood flow in the superior vena cava, caused by compression from the outside or thrombosis of the vessel itself. SVCS is a manifestation of other diseases, in particular lung cancer. Therefore, when there are signs of superior vena cava syndrome, you should immediately consult a doctor and conduct a comprehensive examination. What is the cause of kava syndrome, symptoms and methods of therapy - in detail in the article.

Features of anatomy and provoking factors

The superior vena cava is located in the mediastinum. It is adjacent to the bronchi, chest wall, trachea, lymph nodes, aorta. The defeat of these organs or an increase in their size can cause compression of the indicated vessel and a violation of the outflow of blood from the upper body, i.e. from the head, heart, lungs, upper chest. Thus, when kava syndrome occurs, life-threatening conditions can occur. Manifestations of this disease often occur in men from 30 to 60 years. Such patients are usually faced by cardiologists, pulmonologists, phlebologists, oncologists. The mechanisms of occurrence of cava syndrome are tumor invasion into the vessel wall, compression from the outside, and thrombosis.

The most common cause of superior vena cava syndrome is lung cancer. However, tumor invasion into the wall of the superior vena cava can also be triggered by the following neoplasms:

• Sarcoma.
• Lymphoma.
• Melanoma.
• Tumors of the digestive organs located near the vein.
• Mammary cancer.

Non-tumor causes of cava syndrome are as follows: retrosternal goiter, cardiovascular insufficiency, infectious diseases, purulent mediastinitis, post-radiation fibrosis, constrictive pericarditis, idiopathic mediastinal fibrosis, sarcoidosis, mediastinal teratoma, prolonged catheter in the superior vena cava, aortic aneurysm. Compression of the terminal section of the superior vena cava can cause expansion of the inferior vena cava, the causes of obstruction of blood flow in which are also quite diverse and no less dangerous to health.

Most often, the syndrome occurs due to lung cancer.

Main manifestations

The syndrome of impaired blood flow in the superior vena cava is characterized by three main syndromes: cyanosis, swelling, and an increase in the diameter of the superficial veins of the upper half of the body. Patients are concerned about shortness of breath at rest, difficulty swallowing, hoarseness, cough, swelling of the face and neck. All these symptoms are greatly aggravated at rest, so a person suffering from this ailment tends to take a semi-recumbent position.

Somewhat less often, symptoms of suffocation develop due to swelling of the larynx. This can lead to respiratory failure. Due to a violation of the outflow of venous blood, cerebral edema may develop. This causes symptoms such as headaches, convulsions, confusion, tinnitus, drowsiness, loss of consciousness.

Somewhat less often, symptoms of impaired functioning of the oculomotor and auditory nerves develop, expressed in lacrimation, double vision, exophthalmos, auditory hallucinations, hearing loss, and tinnitus.

An increase in pressure in the vein system leads to nasal, esophageal and pulmonary bleeding. In addition, there is swelling of the collar zone and upper limbs, cyanosis of the skin. These symptoms are clearly visible in the photo.

Ways to identify the disease

Apart from standard methods examinations, including a survey of the patient, visual examination and laboratory tests, in establishing a diagnosis, such diagnostic methods are used as:

• Radiography in two projections.
• Computed and magnetic tomogram.

Additional research methods aimed at detecting the cause of the syndrome include: examination of the fundus, measurement of intraocular pressure, bronchoscopy, sputum analysis, ultrasound of the carotid and supraclavicular veins, sternal puncture. In case of emergency, it is possible to perform diagnostic thoracoscopy and parasternal thoracotomy.

To identify the disease, you can use the method of phlebography.

Therapy Methods

Treatment for superior vena cava syndrome includes complex therapy aimed at eliminating the cause of this condition and alleviating the patient's condition. This can be achieved using conservative and surgical methods.

Conservative treatment includes:

• Oxygen inhalations used for obstruction respiratory tract, as well as tracheostomy, tracheal intubation.
• With cerebral edema, diuretics and glucocorticosteroids are prescribed. If necessary, anticonvulsants are added to the treatment.
• In the presence of a malignant neoplasm, treatment should begin with radiation therapy. When combined with intercellular lung cancer with lymphoma, chemotherapy is added to radiation therapy.
• Percutaneous stenting helps to manage the lack of air.

If the cause of blood flow disturbance in the superior vena cava is a thrombus, then treatment is carried out with fibrinolytic drugs. In the absence of the effect of conservative treatment or with a significant deterioration in the health of the patient, surgical intervention is performed.

If the superior vena cava is compressed from the outside, then a radical removal of the tumor is performed. If such surgical treatment is not possible, then palliative surgery is performed. Among the methods aimed at improving the patient's condition, the following are distinguished: bypass shunting, stenting, percutaneous endovascular balloon angioplasty, removal of a part of the neoplasm for the purpose of decompression.

Thus, the syndrome resulting from impaired blood flow in the superior vena cava can manifest itself with several ambiguous signs at once. Therefore, it is important to know its main symptoms. Depending on the severity of the condition and the cause of its occurrence, a method of treatment is selected, respectively, the earlier the disease causing this syndrome is detected, the more complications can be avoided.

Superior vena cava syndrome is a disorder that is a violation of the outflow of venous blood from the upper body (impaired circulation). The basis of such an ailment is the squeezing of a vein or the occurrence of a blood clot, which actually disrupts its outflow from the head, shoulders and upper half of the body. This can lead to serious complications that can threaten a person's life. A similar disorder is often diagnosed between the ages of thirty and sixty years (in males several times more often than in women).

Main clinical manifestations diseases are - the appearance of a bluish tint on the skin, the formation of shortness of breath, a change in the timbre of the voice, swelling of the face and neck, difficulty breathing, pain in the chest, as well as fainting or convulsive condition. Secondary symptoms include decreased hearing and visual acuity.

Diagnostic measures include performing radiography, ultrasound, MRI, CT and other instrumental examinations of the chest. Treatment of the disease is aimed at eliminating the pathology through surgical operations.

Etiology

There are many reasons for the formation of such a pathology, the main of which are:

• external compression of the vein;
• thrombus formation;
• the formation of a malignant tumor of the right lung is the main factor in the occurrence of such a pathology.

Other predisposing factors may be:

• tumors of the digestive system of a different nature, which are located in the area of ​​the diaphragm;

In addition, a similar disorder can be observed during the course of certain diseases. Among which:

• goiter of the retrosternal region;
• cardiovascular insufficiency;
• pathological effects of pathogens;
• a wide variety ;
• growth of fibrous tissue.

There is a possibility of an ailment as a response of the body to surgery, as well as from prolonged use of a venous catheter.

Symptoms

emergence characteristic features It is caused by an increase in pressure in the vessels, and the degree of their manifestation is influenced by the rate of progression of the pathological process and the degree of circulatory disorders. The main symptoms of the disease include:

• bouts of severe headache;
• the occurrence of shortness of breath not only with physical activity, but also at rest;
• difficult breathing process;
• soreness in the retrosternal region;
• cyanosis of the skin of the upper body;
• change in voice tone. Often he becomes hoarse, a person constantly wants to clear his throat;
• swelling of the face and neck;
• constant drowsiness and lethargy;
• the appearance of seizures;
• fainting.

Secondary signs of this syndrome are the patient's complaints of hearing loss and visual acuity, the occurrence of tinnitus, as well as auditory hallucinations and increased tearing. The intensity of the manifestation of symptoms is individual for each person, which is determined by the rate of spread of the pathogenic process. The greater the compression of the vein, the smaller its lumen, which further disrupts blood circulation.

Diagnostics

Diagnostic measures for establishing the diagnosis of "syndrome of the superior vena cava" are based on an instrumental examination of the patient. But before that, the doctor needs to get acquainted with the history of the disease, find out possible reasons the formation of the disease, as well as the presence and degree of intensity of symptoms.

Instrumental diagnostic methods include:

• radiography of the chest area. Pictures are taken in several projections;
• tomography - in particular computer, spiral and MRI;
• phlebography - carried out to identify the location of the pathogenic process;
• Ultrasound of veins - such as carotid and supraclavicular;
• bronchoscopy - will help determine the causes of the formation of the disease, with the obligatory implementation of a biopsy;
• laboratory tests of sputum.

If necessary, diagnostic thoracoscopy, mediastinoscopy and consultation with an ophthalmologist are prescribed, during the cortex, intraocular pressure is measured. In addition, it is necessary to differentiate this pathology from congestive heart failure. After receiving all the results of the examinations, the doctor prescribes the most effective treatment tactics for each patient.

Treatment

General therapeutic measures for all patients consist of constant inhalation of oxygen, sedatives medicines, diuretics and glucocorticoids, compliance with a low-salt diet and bed rest.

Further treatment for each patient individually and depends on the causes of such a syndrome:

• if the disease was caused by oncology of the right lung, metastases or other malignant neoplasms, then patients are prescribed chemotherapy or radiation treatment;
• in cases of the formation of the disease against the background of thrombosis, thrombectomy is performed, often with the removal of the affected part of the vena cava, followed by the establishment of a homotransplant.

If it is impossible to carry out radical surgical operations, other methods of treatment are prescribed to restore the outflow of venous blood:

• removal of a benign neoplasm of the mediastinum;
• bypass shunting;
• percutaneous balloon angioplasty;
• stenting of the superior vena cava.

In most situations, the treatment of the disease is gradual and gradual, but sometimes an emergency operation may be required. This is necessary when:

• acute, which can lead to cardiac arrest;
• obvious difficulty in performing respiratory functions;
• brain lesions.

There is no specific prevention of such a disease. The prognosis of the disease depends on the causes of such a disorder and timely therapy. Elimination of progression factors allows you to completely get rid of the syndrome. An acute course of the disease can lead to a quick death of a person. If the disease was caused by an advanced form of oncology, the prognosis is extremely unfavorable.

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Diseases with similar symptoms:

As is known, respiratory function body is one of the main functions of the normal life of the body. The syndrome, in which the balance of blood components is disturbed, and to be more precise, the concentration of carbon dioxide greatly increases and the volume of oxygen decreases, is called "acute respiratory failure", it can also turn into chronic form. How does the patient feel in this case, what symptoms may bother him, what signs and causes of this syndrome - read below. Also from our article you will learn about diagnostic methods and the most modern methods of treating this disease.

Vein cancer is an oncological disease characterized by the formation of cancer cells on the inner surface of the venous vessels, which can be observed in almost all parts of the body. The most common sites of localization of malignant lesions of the veins are: skin, mammary gland, liver, spleen. According to statistics, angiosarcoma is predominantly found in the skin of the scalp and face.

Causes of vein cancer

The true cause of the occurrence of genetic mutations has not been established to date. Numerous scientific studies draw attention to blood flow disorders in venous vessels as the main provoking factor of angiosarcoma. Such pathological condition very often occurs with varicose veins and the formation of blood clots in the lumen of the vessel.

In addition, risk factors for venous oncology are considered to be:

• genetic predisposition.
• Exposure to ionizing radiation during the treatment of concomitant cancer.
• Influence of carcinogenic factors (arsenic, thorium dioxide).

Symptoms of vein cancer

vein cancer manifests itself differently depending on the depth of tissue damage. Angiosarcoma of the subcutaneous layer of the epithelium has the appearance of a dense nodular lesion, which is visible on the surface of the skin as a purple spot. deep veins, as a rule, are diagnosed in the later stages of the pathology, due to compression of nerve fibers and neighboring organs.

At the onset of the disease pain are weak and unsystematic. At the same time, attacks of joint pain in stages I and II are stopped with the help of traditional painkillers. In the advanced period of oncological disease, patients experience unbearable pain, which is relieved only by narcotic analeptics.

Frequent complaints in patients with angiosarcoma are swelling and protrusion in the affected area.

Common signs of vein cancer:

• General malaise, frequent headache, fatigue, loss of working capacity.
• Subfebrile body temperature.
• Decreased appetite and, as a result, a sharp loss of body weight.

Diagnostics of oncology of veins

An oncologist is engaged in the diagnosis of cancerous lesions of the vessels, who, after conducting a visual and palpation examination of the patient, prescribes additional methods for determining the disease.

1. X-ray examination, which is necessary to determine the localization of the tumor and its prevalence.
2. Computed tomography is a method of layer-by-layer scanning of a pathological part of the body, during which the doctor establishes the structure of mutated tissues.
3. Magnetic resonance imaging allows you to detect the smallest constituent elements of a cancerous neoplasm.

The final diagnosis of vein cancer is established on the basis of a biopsy, which consists in removing a small area of ​​pathological tissue for microscopic examination. The result of the histological and cytological study of biological material is the identification of the tissue structure of the tumor and the stage of development of oncology. Most angiosarcomas have a high degree differentiation, which leads to aggressive growth of the neoplasm and early formation of metastases.

Methods for the treatment of vein cancer

• Surgical excision

It is considered the main radical treatment for all forms of angiosarcomas. In some cases, surgeons resort to the practice of gradual removal of the tumor, especially when the neoplasm is large or close to vital human organs. Often, the exact area of ​​tissue to be removed is determined directly during surgery.

• Neoadjuvant therapy

Refers to the preoperative preparation of the patient and includes the use of radiation exposure and chemotherapy.

1. Radiation therapy consists of destroying cancer cells or stabilizing cancer growth using high-energy x-rays.
2. Chemotherapy involves the patient taking a course of cytostatic pharmacological preparations, which have a detrimental effect on malignant tissues.

• adjuvant therapy

It is a complex of medical procedures used in the postoperative period to prevent systemic relapses of the disease. The therapeutic effect is achieved by individual selection of the required radiation dose and concentration of chemotherapeutic agents.

Postoperative period

Patients operated on for angiosarcoma are advised to undergo quarterly medical visits during the first two years. After that, doctors conduct scheduled examinations of patients every six months. After five years, the frequency of visits to a medical institution is reduced to once a year.

Disease prognosis

Early diagnosis and timely treatment of vein cancer is of key importance in achieving a positive long-term outcome of therapy.

In 50% of clinical cases, a venous tumor is diagnosed together with the presence of metastases. The late stage of cancer, especially with the formation of secondary foci of malignant lesions, causes an unfavorable prognosis of the disease.

Vascular surgeons believe that the deeper the angiosarcoma is localized, the more negative the five-year survival rates of patients.

Superior vena cava syndrome (SVCS) or cava syndrome is a whole complex of symptoms that occur as a result of impaired blood flow in the pool of the vessel of the same name. Due to circulatory disorders in this area, the outflow of blood from the venous vessels in the upper parts of the body is difficult. This pathology is manifested by blueness of the skin, mucous membranes, dilatation of the saphenous veins, shortness of breath, hoarseness, cough, etc. You can recognize the patient by the flabby head, neck, arms, upper half of the torso.

SVCS is a serious pathology that threatens the life of the patient. When the integrity of the vein wall is damaged, an acute violation of blood flow occurs. When the pressure in the vessel rises to 250 mm Hg / st, medical assistance is indispensable, otherwise the patient will die. That is why it is so important to detect characteristic symptoms and transport the patient to a medical facility.

Kava syndrome - basic information

To better understand what superior vena cava syndrome is, you need to delve into the anatomy of the chest. The superior vena cava (SVC) is an important blood vessel that is located in the middle mediastinum, and around it is chest wall, trachea, bronchi, aorta, lymph nodes. SVC takes blood from the head, neck, arms, upper half of the body. There is low pressure in this vessel, and this is quite normal. It is for this reason that any pathology of nearby tissues can damage the thin wall of the venous vessel and seriously disrupt blood flow.

Thanks to the system of anastomoses (the junction of two blood vessels), the body independently copes with the violation of the patency of the SVC. But when the pressure rises to 250 mm Hg / st, then a crisis sets in. This is a very dangerous condition, so the patient needs urgent health care otherwise death is inevitable.

SVCS is a secondary disease that complicates many pathologies associated with damage to the organs of the chest cavity. The pathology is based on compression or SVC, as a result of which the outflow of blood through the veins from the head, neck, arms and organs of the upper half of the torso is disturbed. Such a breach threatens dangerous complications. At risk are men from 30 to 60 years old.

The superior vena cava is located in the middle mediastinum, next to the aorta, trachea and bronchi

Causes

To understand how the syndrome of compression of the superior vena cava occurs, you need to know how it functions. The superior and inferior veins empty into the right atrium. During the relaxation of the atrium, oxygen-poor blood is pumped into it. From there, it is fed into the right ventricle, and then into the pulmonary artery, and in the lungs, venous blood is saturated with oxygen. Then arterial (oxygenated) blood returns through 4 pulmonary venous vessels to the left atrium, from where it goes to the left ventricle, then to the aorta and to all organs.

The inferior vena cava takes the used blood from the organs that are located under the diaphragm, and the SVC from the organs above the diaphragm. The pools of these vessels are clearly separated, but there are fistulas between them. With stenosis of the SVC, excess blood is discharged through the anastomoses into the inferior vena cava.

Superior vena cava syndrome is provoked by malignant tumors and thrombosis

The walls of the SVC are very thin, so the blood from the head moves almost under the influence of gravity. The muscles of the upper limbs help speed up its movement. Near the SVC there is a powerful aorta, a strong trachea and bronchi, a large number of lymph nodes. With the development of metastases in these anatomical structures The ERW subsides and no longer copes with its function.

malignant tumors in lymph nodes deform them, due to which the section of the vein is compressed. With a tumor lesion of the mediastinum due to cancer lymphatic system or lung patency of the SVC is impaired. In addition to the tumor, there is a possibility of vascular thrombosis due to tumor lesions of the digestive tract or ovaries. Thus, venous congestion is provoked by tumors, metastases, and blood clots.

Symptoms

Symptoms of the superior vena cava syndrome are caused by impaired venous blood flow in the SVC system. On the clinical picture affects the rate of development of cava syndrome, as well as the degree of blood flow disturbance. Depending on these indicators, SVC may develop slowly (with compression or invasion of the vessel) or quickly (with blockage of the SVC by blood clots).

The patient's upper body swells, the skin of the face and neck turns blue

The SVCS clinic includes swelling of the face, neck, arms, upper half of the torso due to the expansion of superficial venous vessels, as well as blueness of the skin and mucous membranes. In addition, patients complain of shortness of breath, a feeling of lack of air, hoarseness, difficulty swallowing, coughing fits and pain in chest. Strengthening of these signs is observed when the patient assumes a horizontal position, so they are forced to be in a semi-sitting position. Because of the swelling of the larynx, stridor appears (whistling noisy breathing, a rough and hoarse voice).

Often SVCS is accompanied by nasal, pulmonary, gastric, intestinal hemorrhages due to increased venous pressure and rupture of thinned vessels. Impaired venous outflow from the cranium provokes headache, noises, drowsiness, convulsions, fainting. The functionality of the oculomotor or auditory nerves is impaired, double vision develops, protrusion of the eyeballs, excessive release of lacrimal fluid, and various hearing disorders.

Diagnostic Measures

Physical diagnosis will help identify the characteristic symptoms of SVCS. As a result of a visual examination, the doctor can easily determine the expansion of the veins in the neck and chest, the blue of the face, and the swelling of the upper torso. If SVCS is suspected, a chest X-ray in two projections is prescribed. If necessary, conduct a computer, magnetic resonance imaging. To identify the location and severity of SVC obstruction, phlebography is prescribed.

If SVCS is suspected, x-rays are ordered

To diagnose blockage of a venous vessel by a thrombus or its compression from the outside, ultrasound Dopplerography of the carotid and supraclavicular veins is performed.

The ophthalmologist will determine the eye disorders characteristic of SVCS:

• tortuous and dilated veins of the fundus;
• swelling of the peripapillary area;
• non-inflammatory edema of the optic nerve;
• increased intraocular fluid pressure.

To determine the causes of SVCS and confirm the morphological (tumor genesis) diagnosis, bronchoscopy is performed with tissue sampling, as well as bronchial sputum, which are examined for the presence of atypical cells. Also carry out microscopic studies washing waters from the deep sections of the bronchial tree. In addition, lymph node cells are taken and sternal puncture is performed.

If necessary, the doctor prescribes additional studies:

• videothoracoscopy;
• mediastinoscopy;
• mediastinotomy, etc.

Differential diagnosis of SVCS is carried out with functional heart failure. In the pathology of the superior vena cava, there is no peripheral edema, accumulation of transudate (non-inflammatory fluid) in the pleural cavity, and abdominal dropsy.

Treatment Methods

Symptomatic treatment pathology is carried out in order to increase the functional reserves of the body. The patient must follow a low-salt diet, he is prescribed oxygen inhalations, diuretics and glucocorticoid drugs. After the doctor establishes the causes of the development of SVCS, pathogenetic treatment is carried out.

If the disease provoked lung cancer, lymphoma (oncological lesions of the lymphatic tissues), Hodzhikin's disease, metastases, polychemotherapy and radiation therapy are prescribed. If SVCS is caused by blockage of the superior vena cava with blood clots, then thrombolytic treatment is performed, an operation to remove the clot. And sometimes it is necessary to remove a portion of the vein, which is replaced with a homograft.

Treat the underlying disease to eliminate the symptoms of SVCS

With extravasal compression of the superior vena cava, surgical intervention is also indispensable. The surgeon may remove a mediastinal tumor or cyst, mediastinal lymphoma, etc. If for some reason surgical intervention is contraindicated, then a palliative operation is prescribed, which improves venous outflow.

The prognosis of SVC syndrome depends on the primary disease and the possibility of surgical intervention. After the elimination of the underlying causes, the signs of the syndrome of the superior vena cava disappear. In the acute course of kava syndrome, the likelihood of a quick death of the patient increases. If the SVPV is called by a running cancer, the prognosis is poor. That is why it is important to identify the pathology in time and treat it.