Superior vena cava syndrome: A real-world analysis of 91 cases

Abstract

Background

Superior vena cava (SVCS) is an uncommon but potentially life-threatening condition caused by partial or complete obstruction of venous return through the superior vena cava, most commonly due to malignancy or catheter-related thrombosis. While SVCS is clinically relevant, contemporary data describing its presentation, management, and outcomes remain limited. The primary objective of this study was to describe the clinical characteristics, treatments, and outcomes of this population, and the secondary objective was to identify factors associated with mortality.

Method

Retrospective, single-center observational study including patients over 18 years of age diagnosed with SVCS between 2012 and 2023. Data were collected from electronic medical records. SVCS was confirmed by imaging. Life-threatening presentations were defined by the presence of cerebral or laryngeal edema, hemodynamic instability, or ICU admission.

Results

Ninety-one patients were included (mean age 59.5 years; 51.6% women). Most cases were malignancy-related (90.1%), primarily lung cancer (50.5%). At diagnosis, 26.4% had life-threatening symptoms and 19.8% had concurrent venous thromboembolism. Interventional treatment was required in 38.4%, with stenting being the most common procedure. During follow-up (median 124 days), 82.4% of patients died, mainly from cancer progression. Mortality was associated with older age, corticosteroid use, and malignancy. Thrombotic etiology and incidental diagnosis were linked to better outcomes. In multivariate analysis, lung cancer remained an independent predictor of mortality (OR 4.67; 95% CI: 1.05–23.4).

Conclusion

In this cohort, SVCS was predominantly associated with malignancy, mainly lung cancer, and carried a high mortality rate. Catheter-related and thrombotic SVCS showed more favorable outcomes, emphasizing the prognostic importance of the underlying etiology.

Resumen

Introducción

El síndrome de vena cava superior (SVCS) es poco frecuente pero potencialmente letal. Está causado por la obstrucción del retorno venoso a nivel de la vena cava superior, generalmente debida a neoplasia o trombosis asociada a catéter. Los datos contemporáneos que describen su presentación, tratamiento y desenlaces son limitados. El objetivo primario de este estudio fue describir las características clínicas, los tratamientos y los desenlaces, y el secundario identificar factores asociados con mortalidad.

Métodos

Estudio retrospectivo, unicéntrico y observacional incluyendo pacientes adultos diagnosticados de SVCS entre 2012 y 2023. Se recogieron datos de historias clínicas. El SVCS se confirmó por imagen. Se definió una presentación de riesgo letal como edema cerebral o laríngeo, inestabilidad hemodinámica o necesidad de ingreso en Cuidados Intensivos.

Resultados

91 pacientes fueron incluidos (edad media 59.5 años, 51.6% mujeres). La mayoría se asociaron a cáncer (90.1%), principalmente de pulmón (50.5%). Al diagnóstico, 26.4% presentaban cuadros de riesgo vital y 19.8% trombosis venosa concurrente. El 38.4% precisó tratamiento intervencionista, siendo el stent el más común. Durante el seguimiento (mediana 124 días), 82.4% fallecieron, principalmente por progresión oncológica. La edad avanzada, uso de corticoides y cáncer (especialmente pulmonar) se asociaron con mayor mortalidad, mientras que la etiología trombótica y el diagnóstico incidental presentaron mejor pronóstico. En el análisis multivariante, la neoplasia de pulmón fue un factor predictor independiente de mortalidad (OR 4.67; 95% IC: 1.05-23.4).

Conclusión

Este estudio describe el SVCS en una cohorte actualizada y señala los factores asociados con mortalidad.