Hybrid approach: vascular surgical and image-guided intervention for BroCa-induced superior vena cava syndrome (SVCS)

The aim of this study was to compare the outcome of a novel hybrid technique with the results of conventional approaches when treating tumor-induced superior vena cava syndrome (SVCS). The failure of a thrombectomy via transjugular aspiration led to an interdisciplinary approach to treat malignant SVCS.

The technique is relatively unknown but is performable if vascular surgeons and interventional radiologists work side by side in the operating room. We give an in-depth description of the hybrid technique, including surgical thrombectomy of the SVC, left brachiocephalic vein and left subclavian vein, occlusion balloon placement, stenting of the SVC and left brachiocephalic vein and the imaging controls. The equipment needed for this approach must be in the operating room and may only be available in bigger hospitals.

Tumor-induced SVCS is an urgent case that sometimes cannot wait for radiotherapy or chemotherapy to reduce the tumor mass compressing the SVC. The results of our hybrid technique included almost complete relief of SVCS symptoms within 24 hours. The patient was discharged two days after surgery.

Treatment provided the advantages associated with limited invasiveness, i.e., a faster and complication-free recovery period. The procedure may be a suitable alternative to open surgical intervention, as it involves less invasive trauma and has a reasonable risk-benefit ratio with a good chance of technical and clinical success. Further studies are warranted to better assess the complication rates with this hybrid technique.