What is SVC Syndrome?
Superior Vena Cava (SVC) is the large vein that returns blood to the heart and lungs from the head and arms and “SVC Syndrome” is a condition where the SVC is narrowed which results in increased pressure in the head and arms. This condition is most commonly caused by scar tissue forming in the SVC from dialysis catheters, pacemaker leads and chemo port catheters. External SVC compression can also occur due to enlarged lymph nodes from conditions such as sarcoidosis or lymphoma.
SVC Syndrome affects many people with 15,000 new cases each year in the US, most commonly due to long-term indwelling venous catheters.
If you have SVC Syndrome, you will experience increased pressure in your head and the resulting conditions will include:
- Chronic headaches
- Facial swelling
- Arm swelling
How is SVC Syndrome treated?
After diagnosis with imaging and clinic consultation at ECCO, SVC Syndrome may be treated one of two ways:
- Pharmacologic Management
- Venogram with Intervention
What is Pharmacologic Management?
Before our physicians recommend any kind of intervention we may pursue management with medications. This type of management would prescribe medication to thin the blood to prevent further narrowing or clotting of the affected veins.
What is Venogram with Intervention?
“Veno” means vein and “Gram” means picture. So, using ultrasound guidance our physicians inject dye into your veins and use X-ray technology to “see” the veins and assess their functionality to determine the correct treatment plan. Once the proper path is determined, a vein in either your arm, leg or neck is then perforated with a hallow needle, using ultrasound guidance. A wire is then advanced, under X-ray guidance, into the vein.
Next, depending on your need, possible interventions include:
- Angioplasty: Specialized balloons can be advanced over the wire and inflated to open blockages or narrowed veins.
- Stent placement: Stents (tubular metal scaffolds) can be placed in the vein to keep it open if the vein cannot stay open on its own.
- Embolization: If indicated, we can use coils or plugs to shut down a non functional vein.
- Thrombolysis: If there is a large amount of clot (known as Deep Vein Thrombosis, or DVT) in the arm, leg, abdomen, etc., a specialized catheter can be temporarily placed within the clot itself which emits a medication that dissolves the clot on contact. This may be done over a 24-hour period involving an ICU stay.
In some cases, Intravascular ultrasound (IVUS) may also be used to evaluate the veins internally.
These interventions are performed as outpatient procedures at ECCO or a local hospital. Depending on the condition being treated, the procedure may require general anesthesia, and in many cases can be done with moderate sedation. Since there are no incisions, recovery time is brief. The main limitation is no heavy lifting (defined as > 15 lbs) for five days following the procedure. Occasionally, temporary blood thinners may be needed following the treatment.
What conditions are treated with a Venogram?
The list is long, but some of the more common conditions treated are:
- DVT (acute and chronic)
- May-Thurner Syndrome
- Pelvic Congestion Syndrome
- SVC Syndrome