Superior vena cava syndrome natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
If left untreated, [[Patient|patients]] with [[superior vena cava syndrome]] may progress to develop a complete [[blood]] flow obstruction and a decreased [[cardiac output]] with [[hypotension]], leading to [[heart failure]] and death. Common [[Complication (medicine)|complications]] of [[superior vena cava syndrome]] include [[airway obstruction]], increased [[ICP]], [[laryngeal edema]], and [[cerebral edema]]. The [[prognosis]] will vary depending on the cause of the syndrome, and the amount of blockage that has already occurred. [[Prognosis]] is generally poor and the [[survival rate]] of [[Patient|patients]] with [[superior vena cava syndrome]] is approximately 10-20% at 6 months.<ref name="pmid17476012">{{cite journal |vauthors=Wilson LD, Detterbeck FC, Yahalom J |title=Clinical practice. Superior vena cava syndrome with malignant causes |journal=N. Engl. J. Med. |volume=356 |issue=18 |pages=1862–9 |year=2007 |pmid=17476012 |doi=10.1056/NEJMcp067190 |url=}}</ref>


If left untreated, patients with superior vena cava syndrome may progress to develop a complete obstruction and a decreased cardiac output with hypotension, leading to heart failure and death. Common complications of superior vena cava syndrome include airway obstruction, increased [[ICP]], laryngeal edema and cerebral edema. The prognosis will vary depending on the cause of the syndrome, and the amount of blockage that has already occurred. Prognosis is generally poor, and the survival rate of patients with SVCS is approximately 10-20% at 6 months.<ref name="pmid17476012">{{cite journal |vauthors=Wilson LD, Detterbeck FC, Yahalom J |title=Clinical practice. Superior vena cava syndrome with malignant causes |journal=N. Engl. J. Med. |volume=356 |issue=18 |pages=1862–9 |year=2007 |pmid=17476012 |doi=10.1056/NEJMcp067190 |url=}}</ref>
==Natural History==
If left untreated, [[Patient|patients]] with [[superior vena cava syndrome]] may progress to develop a complete [[blood flow]] [[obstruction]] and a decreased [[Cardiac output|cardiac outpu]]<nowiki/>t with [[hypotension]], leading to [[heart failure]] and death. Common [[complications]] of [[superior vena cava syndrome]] include [[airway obstruction]], increased [[ICP]], [[laryngeal edema]], and [[cerebral edema]].


==Complications==
==Complications==


Complications that can develop as a result of superior vena cava syndrome are, the following:<ref name="pmid17476012">{{cite journal |vauthors=Wilson LD, Detterbeck FC, Yahalom J |title=Clinical practice. Superior vena cava syndrome with malignant causes |journal=N. Engl. J. Med. |volume=356 |issue=18 |pages=1862–9 |year=2007 |pmid=17476012 |doi=10.1056/NEJMcp067190 |url=}}</ref>
[[Complications]] that can develop as a result of [[superior vena cava syndrome]] are the following:<ref name="pmid17476012">{{cite journal |vauthors=Wilson LD, Detterbeck FC, Yahalom J |title=Clinical practice. Superior vena cava syndrome with malignant causes |journal=N. Engl. J. Med. |volume=356 |issue=18 |pages=1862–9 |year=2007 |pmid=17476012 |doi=10.1056/NEJMcp067190 |url=}}</ref>
*Airway obstruction  
*[[Airway obstruction]]
*Laryngeal edema
*[[Laryngeal edema]]
*Cerebral edema
*[[Cerebral edema]]
*Decreased cardiac output with hypotension
*Decreased [[cardiac output]] with [[hypotension]]
*Pulmonary embolism  
*[[Pulmonary embolism]]


==Prognosis==
==Prognosis==


The prognosis of superior vena cava syndrome is good with treatment. Without treatment, superior vena cava syndrome will result in a torpid clinical evolution associated with a 10- 20% mortality within 6 months. The presence of thoracic malignancies is associated with a particularly poor prognosis among patients with superior vena cava syndrome.<ref name="pmid16502166">{{cite journal |vauthors=Uberoi R |title=Quality assurance guidelines for superior vena cava stenting in malignant disease |journal=Cardiovasc Intervent Radiol |volume=29 |issue=3 |pages=319–22 |year=2006 |pmid=16502166 |doi=10.1007/s00270-005-0284-9 |url=}}</ref>
*The [[prognosis]] of [[superior vena cava syndrome]] is good with treatment.  
 
*Without [[Treatment IND|treatment]], [[superior vena cava syndrome]] will result in a rapid clinical evolution associated with a 10-20% [[mortality]] within 6 months.  
Prognosis is also associated with the acute or long onset of the disease. Acute onset, is relate with more severe symptoms because of absent collateral vein. Therefore there is no distention to accommodate an increased blood flow. However, chronic onset is related with less severe symptoms because there is a presence of collateral veins that compensate increased flow.<ref name="pmid17476012">{{cite journal |vauthors=Wilson LD, Detterbeck FC, Yahalom J |title=Clinical practice. Superior vena cava syndrome with malignant causes |journal=N. Engl. J. Med. |volume=356 |issue=18 |pages=1862–9 |year=2007 |pmid=17476012 |doi=10.1056/NEJMcp067190 |url=}}</ref>
*The presence of [[Malignancies|thoracic malignancies]] is associated with a particularly poor [[prognosis]] among patients with [[superior vena cava syndrome]].<ref name="pmid16502166">{{cite journal |vauthors=Uberoi R |title=Quality assurance guidelines for superior vena cava stenting in malignant disease |journal=Cardiovasc Intervent Radiol |volume=29 |issue=3 |pages=319–22 |year=2006 |pmid=16502166 |doi=10.1007/s00270-005-0284-9 |url=}}</ref>
*[[Prognosis]] is also associated with the acute or gradual onset of the disease. Acute onset, relates with more severe symptoms because of absent collateral veins. Therefore there is no distention to accommodate the increased [[blood]] flow.  
*Chronic onset is related with less severe [[Symptom|symptoms]] because there is a presence of [[Vein|collateral veins]] that compensate increased flow.<ref name="pmid17476012">{{cite journal |vauthors=Wilson LD, Detterbeck FC, Yahalom J |title=Clinical practice. Superior vena cava syndrome with malignant causes |journal=N. Engl. J. Med. |volume=356 |issue=18 |pages=1862–9 |year=2007 |pmid=17476012 |doi=10.1056/NEJMcp067190 |url=}}</ref>
*[[Patients]] with [[small cell]] [[bronchogenic carcinoma]] treated with chemotherapy and that simultaneously course with [[superior vena cava syndrome]], the 2-year [[survival rate]] is 3%.
*[[Patient|Patients]] treated with [[radiation therapy]], the relief of symptoms is greater, however the 2-year [[survival rate]] of 5% is almost the same for both groups.<ref name="pmid17476012">{{cite journal |vauthors=Wilson LD, Detterbeck FC, Yahalom J |title=Clinical practice. Superior vena cava syndrome with malignant causes |journal=N. Engl. J. Med. |volume=356 |issue=18 |pages=1862–9 |year=2007 |pmid=17476012 |doi=10.1056/NEJMcp067190 |url=}}</ref>


==References==
==References==

Latest revision as of 13:46, 12 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

If left untreated, patients with superior vena cava syndrome may progress to develop a complete blood flow obstruction and a decreased cardiac output with hypotension, leading to heart failure and death. Common complications of superior vena cava syndrome include airway obstruction, increased ICP, laryngeal edema, and cerebral edema. The prognosis will vary depending on the cause of the syndrome, and the amount of blockage that has already occurred. Prognosis is generally poor and the survival rate of patients with superior vena cava syndrome is approximately 10-20% at 6 months.[1]

Natural History

If left untreated, patients with superior vena cava syndrome may progress to develop a complete blood flow obstruction and a decreased cardiac output with hypotension, leading to heart failure and death. Common complications of superior vena cava syndrome include airway obstruction, increased ICP, laryngeal edema, and cerebral edema.

Complications

Complications that can develop as a result of superior vena cava syndrome are the following:[1]

Prognosis

References

  1. 1.0 1.1 1.2 1.3 Wilson LD, Detterbeck FC, Yahalom J (2007). "Clinical practice. Superior vena cava syndrome with malignant causes". N. Engl. J. Med. 356 (18): 1862–9. doi:10.1056/NEJMcp067190. PMID 17476012.
  2. Uberoi R (2006). "Quality assurance guidelines for superior vena cava stenting in malignant disease". Cardiovasc Intervent Radiol. 29 (3): 319–22. doi:10.1007/s00270-005-0284-9. PMID 16502166.

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