Superior Vena Cava Syndrome

	Spiral vein bypass graft Do I need surgery? Surgery should be considered if symptoms are limiting. CT scanning or bilateral venography is usually required to diagnose the obstruction and to assist in planning the operation.

The superior vena cava is the large vessel that drains blood from the head and arms. Obstruction (blockage) of the superior vena cava impairs this drainage, leaving the arms, neck and head swollen and uncomfortable.

The obstruction can be caused by an external process, such as a tumor or other growth, which gradually narrows the superior vena cava. Internal processes, such as fibrosis (thickening) from infections or long-term devices inside the superior vena, can also create narrowing by gradual scar formation.

Conditions that can produce superior vena cava obstruction include:

• Chronic central venous catheters
• Pacemaker or defibrillator leads
• Fibrosing mediastinitis (histoplasmosis)
• Radiation
• Previous heart surgery

Symptoms develop from superior vena cava obstruction when the narrowing has become severe and there are no collateral (alternative) veins to satisfactorily drain the blood from the head and arms. Symptoms includde:

• Head congestion and swelling
• Fatigue
• Inability to lie flat
• Arm congestion and fatigue
• Difficulty breathing

Surgery can provide excellent long-term relief of these symptoms for patients with benign (not malignant) causes of obstruction. The spiral vein bypass graft operation creates a new superior vena cava from the patient's own saphenous (leg) vein. This new pathway effectively drains the congested blood from the head and neck, relieving the symptoms of obstruction.