Local thrombolytic therapy in superior vena cava syndrome secondary to malignant thymoma: a case report and literature review

Wide en-bloc thymectomy and venous axis reconstruction in Masaoka stage IIIB thymoma: a case report and literature review

Thymomas are rare tumors originating from thymic tissue and rarely metastasize. They can be diagnosed either incidentally or symptomatically when compressing or invading nearby structure. A 36-year-old man presented with significant high-grade fever, chest pain that worsens upon lying down, and dyspnea. A chest X-Ray and computed tomography followed by biopsy confirmed the diagnosis of thymoma. The management included chemotherapy cycles, followed by surgery. Pericardiectomy was performed with en-bloc thymectomy and partial resection of the infiltrating lung. Venous drainage was restored by 8/16 mm inverted bifurcated brachiocephalic-superior vena cava Dacron bypass. The pericardium was reconstructed by a synthetic Dacron patch, and the right diaphragm metastasis was resected. Neoadjuvant chemotherapy was initiated. After 3 months of follow-up, no recurrence was evidenced by computed tomography.

Superior Vena Cava Syndrome: Role of the Interventionalist

Superior vena cava syndrome results from the obstruction of blood flow through the superior vena cava and is most often due to thoracic malignancy. However, benign etiologies are on the rise secondary to more frequent use of intravascular devices such as central venous catheters and pacemakers. Although rarely a medical emergency, the symptoms can be alarming, particularly to the patient. Traditionally, superior vena cava syndrome has been managed with radiotherapy and chemotherapy. But interventional endovascular techniques have made inroads that offer a safe, rapid, and durable response. In many cases, it may be the only reasonable treatment. Because of this, an approach to endovascular treatment of this condition must be in the armamentarium of the interventional radiologist. This review will provide the reader with an insight into the etiology, pathophysiology, and various management principles of superior vena cava syndrome. The focus will be on understanding the techniques used during various endovascular interventions, including angioplasty, stenting, and pharmacomechanical thrombolysis. Discussion will also be centred on possible complications and current evidence as well as controversies regarding these approaches.

Superior vena cava syndrome. Experience with endovascular stents and surgical therapy

Superior vena cava (SVC) syndrome is a serious complication of benign and malignant diseases. Benign causes may be increasing because of the increased use of central venous cannulation. Modern surgical therapy is durable with a few complications. Traditional treatment for SVC obstruction from malignant causes has consisted of anticoagulation, radiation, chemotherapy, and occasionally surgery. Endovascular techniques present a new treatment option for these patients, and uses a combination of thrombolysis, angioplasty, and intravascular stents. Short-term results are excellent with relatively rapid patient recovery. Further research is needed to elucidate the long-term results of endovascular treatment and to find its role in benign and malignant disease.