Surgical treatment of acute superior vena caval syndrome. A report of two cases.

The syndrome caused by the acute obstruction of the superior vena cava with central nervous system symptoms as well as with symptoms related to the oedema of the upper respiratory tract is often very severe and fatal to the patient. Conservative treatment is usually of no help, and consequently the palliative reconstruction of the superior vena cava may be indicated. Two cases of acute superior vena caval syndrome with reconstruction of the superior vena cava are presented. In the first case, when a malignant mediastinal tumour (Hodgkin's) was removed, a segment of the superior vena cava and the anonymous vein had to be removed. Following this operation acute superior vena caval syndrome developed and another operation was performed in which the superior vena cava was reconstructed with a Dacron prosthesis. Radiological examination of the superior vena cava 28 months postoperatively showed the prosthesis patent and the patient was free from symptoms. 51 months after the operation the patient was still asymptomatic. In the second case the obstruction of the superior vena cava was caused by anaplastic carcinoma of the upper lobe of the right lung. The acutely obstructed superior vena cava was reconstructed with a Dacron prosthesis. 9 months postoperatively the superior vena caval syndrome recurred and two months later the patient died of lung cancer. In both cases good palliation of the obstruction of the superior vena cava was obtained.