Upper extremity and cervicofacial edema – stenting for superior vena cava syndrome

       Superior vena cava syndrome is a clinical syndrome characterized by bilateral upper limb and cervicofacial edema caused by stenosis of the superior vena cava due to various causes. The mechanism of its occurrence is the obstruction of venous blood return to the upper extremities and the head, neck and face of the body due to stenosis of the superior vena cava, which leads to venous anger and tissue edema in the upper extremities and the head, neck and face of the body, and even in the upper chest. In severe cases, respiratory distress may develop, leading to cerebral hypoxia and increased intracranial pressure. Examination may reveal bruising and edema in the neck, upper extremities and chest, requiring urgent treatment.       Recently, we saw a patient with lung cancer complicated by superior vena cava syndrome who was successfully treated with superior vena cava stent placement. The case was due to advanced right upper lung cancer, and the patient had bilateral upper limbs and cervical and facial venous rage with severe edema. After the stent was inserted, the venogram showed that the superior vena cava reflux was smooth, and the edema in the upper limbs and neck and face of the patient completely disappeared after 2 days.       Superior vena cava syndrome is a common complication of malignant tumors, and lung cancer is the main cause of this syndrome. 4% of lung cancer patients already have superior vena cava syndrome at diagnosis, and the rest of lung cancer patients may also develop superior vena cava syndrome during the course of the disease. Once patients with lung cancer develop edema in both upper extremities and angry veins in the neck, it often indicates superior vena cava syndrome, and such patients have little chance of surgical removal of the tumor. Traditional radiotherapy and chemotherapy were once considered the standard of care for this syndrome, but according to the literature, the clinical effects of radiotherapy and chemotherapy are still controversial and slow to take effect. Currently, stenting has become the first-line treatment option for superior vena cava syndrome due to malignancy. Stenting is minimally invasive and has immediate clinical efficacy, providing rapid symptomatic relief without affecting the subsequent treatment of the tumor.