Thoracic Central Vein Obstruction Endovascular Recanalization and Reconstruction

Thoracic central vein obstruction (TCVO) refers to occlusive disease of the thoracic central veins leading to compromised venous return from the head, neck, chest, and upper extremities to the right atrium. TCVO has benign and malignant causes and involves intraluminal, intramural, or extravascular obstruction. TCVO is the preferred term to describe the anatomic and/or pathologic process; however, the clinical manifestations (and historically, the anatomic description) are commonly referred to as superior vena cava syndrome. Diagnostic evaluation of patients with suspected TCVO starts with US or venography (ie, typically MR or CT venography but possibly catheter-directed or conventional venography). Treatment of TCVO has evolved, with endovascular therapy emerging as the preferred treatment option to alleviate symptoms rapidly and safely. Endovascular recanalization techniques include thrombectomy, thrombolysis, and blunt or sharp recanalization. Endovascular reconstruction can be performed by means of placement of stents or stent-grafts. Antiplatelet and anticoagulant agents may be used after recanalization and reconstruction to improve patency rates or to treat deep vein thrombosis. Overall, technical and clinical success rates are high and major adverse events are rare, occurring in 1%-2% of patients. ^©RSNA, 2025 Supplemental material is available for this article.