Pulseless Electrical Activity Arrest after SVC Dilation

Superior vena cava syndrome (SVCS) is a constellation of symptoms that develops during stenosis or occlusion of the superior vena cava (SVC) or its main tributaries. Obstruction above the azygos vein causes a moderate increase in venous pressure because blood can be diverted through chest-wall veins into the thoracic and iliac veins and then enters the heart by way of the inferior vena cava and azygos system. Blockage below the level of the azygos vein is not well tolerated because a higher venous pressure is required to pump blood back to the heart through the only patent channel, the inferior vena cava.[1]

High central venous pressure produces a syndrome characterized by dyspnea, facial edema, venous distention of the chest wall and neck veins, and, less often, facial plethora, cough, arm edema, and central nervous system complaints.[2] [3] [4] [5] Although SVCS is a medical emergency that requires immediate diagnostic evaluation and therapy, it is rarely a life-threatening emergency. Symptoms are the most severe if the SVC is blocked quickly and venous collaterals do not have time to expand. Thus development of symptoms can be as rapid as a few weeks for a malignant tumor or gradual over several years for fibrosing mediastinitis.[1]

REFERENCES

• 1 Laskin J, Cmelak A J, Roberts J, Meranze S G, Johnson D H. Superior vena cava syndrome. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG Clinical Oncology. 3rd ed. Philadelphia; Elsevier Churchill Livingstone 2004: 1047-1052
• 2 Parish J M, Marschke Jr R F, Dines D E, Lee R E. Etiologic considerations in superior vena cava syndrome.  Mayo Clin Proc. 1981;  56 407-413
• 3 Bell D R, Woods R L, Levi J A. Superior vena caval obstruction: a 10-year experience.  Med J Aust. 1986;  145 566-568
• 4 Yellin A, Rosen A, Reichert N, Lieberman Y. Superior vena cava syndrome. The myth-the facts.  Am Rev Respir Dis. 1990;  141 1114-1118
• 5 Lochridge S K, Knibbe W P, Doty D B. Obstruction of the superior vena cava.  Surgery. 1979;  85 14-24
• 6 Schraufnagel D E, Hill R, Leech J A, Pare J A. Superior vena caval obstruction: is it a medical emergency?.  Am J Med. 1981;  70 1169-1174
• 7 Rowell N P, Gleeson F V. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review.  Clin Oncol (R Coll Radiol). 2002;  14 338-351
• 8 Chatziioannou A, Alexopoulos T, Mourikis D et al.. Stent therapy for malignant superior vena cava syndrome: should be first line therapy or simple adjunct to radiotherapy.  Eur J Radiol. 2003;  47 247-250
• 9 Uberoi R. Quality assurance guidelines for superior vena cava stenting in malignant disease.  Cardiovasc Intervent Radiol. 2006;  29 319-322
• 10 Neumar R W, Ward K R. Adult resuscitation. In: Marx JA, Hockberger RS, Walls RM Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia; Mosby Elsevier 2006: 79-90
• 11 Albrecht K, Nave H, Breitmeier D, Panning B, Tröger H D. Applied anatomy of the superior vena cava: the carina as a landmark to guide central venous catheter placement.  Br J Anaesth. 2004;  92 75-77
• 12 Brown K T, Getrajdman G I. Balloon dilation of the superior vena cava resulting in SVC rupture and pericardial tamponade: a case report and brief review.  Cardiovasc Intervent Radiol. 2005;  28 372-376