Superior vena cava syndrome: A real-world analysis of 91 cases

Superior vena cava (SVCS) is an uncommon but potentially life-threatening condition caused by partial or complete obstruction of venous return through the superior vena cava, most commonly due to malignancy or catheter-related thrombosis. While SVCS is clinically relevant, contemporary data describing its presentation, management, and outcomes remain limited. The primary objective of this study was to describe the clinical characteristics, treatments, and outcomes of this population, and the secondary objective was to identify factors associated with mortality.

Retrospective, single-center observational study including patients over 18 years of age diagnosed with SVCS between 2012 and 2023. Data were collected from electronic medical records. SVCS was confirmed by imaging. Life-threatening presentations were defined by the presence of cerebral or laryngeal edema, hemodynamic instability, or ICU admission.

Ninety-one patients were included (mean age 59.5 years; 51.6% women). Most cases were malignancy-related (90.1%), primarily lung cancer (50.5%). At diagnosis, 26.4% had life-threatening symptoms and 19.8% had concurrent venous thromboembolism. Interventional treatment was required in 38.4%, with stenting being the most common procedure. During follow-up (median 124 days), 82.4% of patients died, mainly from cancer progression. Mortality was associated with older age, corticosteroid use, and malignancy. Thrombotic etiology and incidental diagnosis were linked to better outcomes. In multivariate analysis, lung cancer remained an independent predictor of mortality (OR 4.67; 95% CI: 1.05-23.4).

In this cohort, SVCS was predominantly associated with malignancy, mainly lung cancer, and carried a high mortality rate. Catheter-related and thrombotic SVCS showed more favorable outcomes, emphasizing the prognostic importance of the underlying etiology.