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2015, Number 1

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Rev Clin Esc Med 2015; 5 (1)

Tema 1-2015: Síndrome de vena cava superior: una emergencia médico quirúrgica

Alvarado AEM, Odio CD

Language: Spanish
References: 55
Page: 11-21
PDF size: 337.30 Kb.


ABSTRACT

Since its first description in 1757, the Superior Vena Cava Syndrome has been a challenge for the clinician. It is a true emergency, since it puts the patient's life in jeopardy. By definition it is the extrinsic or intrinsic obstruction of the Superior Vena Cava. Its etiology has changed over time, it used to be due to infectious causes (syphilitic aneurisms, tuberculosis), now neoplasic etiologies are more frequent and in the last years thrombosis due to the use of indwelling catheters and minimally invasive procedures have become an important cause. Its clinical manifestations are facial edema and in the superior limbs, with collateral circulation and respiratory symptoms, like dyspnea and cough, severe cases present with neurologic symptoms due to cerebral edema. Investigators from Yale University have recently proposed a classification scale that consists in 6 degres, this classification is useful in the treatment and management of the syndrome. Imaging methods continue to be fundamental in the diagnostic and in the cases where the subjacent cause is unknown, more invasive methods are required to define the etiology. Medical treatment with chemotherapy, radiotherapy and the use of thrombolytics are of first choice, but this can vary depending on the etiology, endovascular interventionism it’s quickly becoming a first choice in treatment while surgical management is reserved for severe or refractory cases.


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