Inferior vena cava syndrome: symptoms and treatment. Compression syndrome of the superior vena cava and its symptoms Compression syndrome of the superior vena cava in oncology

Vein cancer is an oncological disease characterized by the formation of cancer cells on the inner surface of the venous vessels, which can be observed in almost all parts of the body. The most common sites of localization of malignant vein lesions are: skin, mammary gland, liver, spleen. According to statistical data, angiosarcoma is predominantly found in the skin of the scalp and face.

Causes of vein cancer

The true cause of genetic mutations has not been established to date. Numerous scientific studies draw attention to disturbances of blood flow in the venous vessels as the main provoking factor of angiosarcoma. This pathological condition very often occurs with varicose veins and the formation of blood clots in the lumen of the vessel.

In addition, the following are considered risk factors for venous oncology:

Genetic predisposition.
Exposure to ionizing radiation during therapy for concomitant cancer.
Influence of carcinogenic factors (arsenic, thorium dioxide).

Symptoms of vein cancer

Vein cancer manifests itself differently depending on the depth of tissue damage. Angiosarcoma of the subcutaneous layer of the epithelium has the appearance of a dense nodular lesion, which is visible on the surface of the skin as a purple spot. deep veins, as a rule, are diagnosed in the later stages of pathology, due to compression of nerve fibers and neighboring organs.

At the onset of the disease, pain is mild and non-systemic. At the same time, attacks of joint pain in stages I and II are stopped with the help of traditional painkillers. In the advanced stage of cancer, patients experience unbearable pain, which can only be relieved with narcotic analeptics.

Frequent complaints in patients with angiosarcoma are swelling and protrusion in the affected area.

Common signs of vein cancer:

General malaise, frequent headaches, fatigue, loss of performance.
Low-grade body temperature.
Decreased appetite and, as a result, a sharp loss of body weight.

Diagnosis of vein oncology

The diagnosis of cancerous lesions of blood vessels is carried out by an oncologist, who, after conducting a visual and palpation examination of the patient, prescribes additional methods for determining the disease.

X-ray examination, which is necessary to determine the location of the tumor and its extent.
Computed tomography is a method of layer-by-layer scanning of a pathological area of the body, during which the doctor establishes the structure of mutated tissues.
Magnetic resonance imaging allows you to detect the smallest components of a cancerous tumor.

The final diagnosis of vein cancer is made on the basis of a biopsy, which involves removing a small area of pathological tissue for microscopic examination. The result of histological and cytological study of biological material is the identification of the tissue structure of the tumor and the stage of development of oncology. Most angiosarcomas have a high degree of differentiation, which causes aggressive growth of the tumor and early formation of metastases.

Treatment methods for vein cancer

Surgical excision

It is considered the main radical treatment method for all forms of angiosarcomas. In some cases, surgeons resort to the practice of stage-by-stage tumor removal, especially when the tumor is significant in size or located close to vital human organs. Often the exact area of tissue removed is determined directly during surgery.

Neoadjuvant therapy

Refers to the preoperative preparation of the patient and includes the use of radiation and chemotherapy.

Radiation therapy involves destroying cancer cells or stabilizing cancer growth using highly active X-rays.
Chemotherapy involves the patient taking a course of cytostatic pharmacological drugs that have a detrimental effect on malignant tissue.

Adjuvant therapy

It is a set of treatment procedures used in the postoperative period to prevent systemic relapses of the disease. The therapeutic effect is achieved by individual selection of the required radiation dose and concentration of chemotherapeutic agents.

Postoperative period

Patients undergoing surgery for angiosarcoma are recommended to have quarterly medical visits for the first two years. After this, doctors conduct routine examinations of patients every six months. After five years, the frequency of visits to a medical facility is reduced to once a year.

Disease prognosis

Early diagnosis and timely treatment of vein cancer is key to achieving a positive long-term outcome of therapy.

In 50% of clinical cases, a venous tumor is diagnosed together with the presence of metastases. The late stage of cancer, especially with the formation of secondary foci of malignant lesions, causes an unfavorable prognosis of the disease.

Vascular surgeons believe that the deeper the angiosarcoma is localized, the more negative the five-year survival rates for patients.

In the rhythm of modern life, diseases that negatively affect the functioning of the circulatory system are becoming increasingly common. Sometimes they can even threaten human life. An example of such diseases is superior vena cava syndrome.

Despite the fact that this disease belongs to a group of well-studied ones, the number of people suffering from it is not decreasing.

The disease is extremely insidious. Often its symptoms hide more serious complications that threaten a person’s life.

Where is it located?

Located in the area from the head to the right atrium. This is a fairly short vessel.

The function is that it collects all the blood saturated with carbon dioxide from the head, neck, arms and lungs.

In cross section, this vessel is about 2 cm in size, the thickness of the walls is insignificant. The position is almost vertical.

At the front there is the thymus gland, and at the back the azygos vein opens into it.

What is thrombosis of the superior vena cava

Known to medical science since 1754. The first description of this serious disease belongs to Gunther.

Thrombosis implies a complete or partial cessation of blood flow in a particular vessel. Consequently, against the background of vascular obstruction, a problem arises in the outflow of blood from the head, as well as the limbs.

The severity of the disease is closely related to the speed of its development. If thrombosis develops quickly, the likelihood of an unfavorable outcome is much higher than with slow progression.

This is due to the fact that in the first case, bypass branches of blood vessels do not have time to form.

It is worth noting that this syndrome is a signal of the presence of more serious pathologies.

Compression can occur due to the presence of malignant tumors in the human body.

Why is it dangerous?

Delayed treatment or refusal of it can have extremely negative consequences.

The blockage causes swelling of the upper body. This may lead to deterioration of vision and hearing.

Auditory hallucinations occur and tearing of the eyes increases. Sometimes there is significant deterioration of vision and pain in the eyes.

Insufficient speed and intensity of blood flow, which occurs due to poor patency of the vessel, provokes the onset of pathological changes in the human brain. They are associated with insufficient oxygen supply to the organ.

This can provoke strokes.

Causes of compression

According to medical statistics, almost 2/3 of all cases of pathology are provoked by the presence of a malignant tumor.

Oncological pathologies that provoke thrombosis manifest themselves in such organs as:

lungs;
mammary gland;
mediastinum;
The lymph nodes.

In addition to cancer, causes may include:

presence of a blood clot;
external compression of the vein;
inflammation of the thymus (often purulent);
tuberculosis;
syphilis;
diseases of the thyroid gland (goiter);
histoplasmosis;
inflammatory process in the esophagus;
inflammation of the trachea;
silicosis.

Sometimes blood clot formation can occur due to wearing a pacemaker. However, such cases are extremely rare.

Symptoms

All the symptoms of the syndrome are associated with the fact that as a result of impaired vascular patency and deterioration of blood flow, blood pressure increases.

Currently, doctors identify 3 main symptoms:

swelling;
cyanosis of the skin;
visible dilated veins.

These signs are called the triad and when they first appear, you should immediately consult a doctor.

There are also disorders of the respiratory system and brain.

Respiratory system symptoms:

dyspnea;
difficulty breathing (especially when lying down);
cough;
chest pain;
whistling while breathing;
frequent feeling of lack of air.

Brain symptoms:

the appearance of fainting;
frequent headaches;
increased drowsiness and fatigue;
convulsions.

Symptoms from the circulatory system:

Significant increase in blood pressure;
Presence of nosebleeds;
The appearance of bruises and internal bleeding.

With the rapid rate of development of the disease, a person’s intracranial pressure can rapidly increase. This in turn provokes swelling of the brain, in some cases even a stroke.

Complications from blockage

In addition to thrombosis of the superior vena cava, there is.

The reasons for its occurrence are largely similar to those of the upper vessel. However, in this case, the lower part of the body will suffer.

Thrombosis of the inferior vena cava is extremely dangerous, because it can provoke development. As a result of this pathology, particles or liquid enter the blood or lymph.

This often leads to the death of a person.

Blockage can cause kidney failure, liver dysfunction and the formation of abdominal dropsy.

It is one of the most dangerous manifestations of thrombosis. Therefore, it is important to diagnose this disease in a timely manner and consult a doctor.

Diagnostics

If you notice any symptoms, you should immediately consult a doctor.

The first contact should be made to a therapist, who, with a direct external examination, will give directions for examinations to the necessary specialists and tests.

Diagnostic methods:

thoracic region.
Doppler ultrasound of the carotid vessels.
. Necessary to clarify the location of the blood clot.

After the tumor has been detected and its location determined, the patient is referred for a biopsy procedure. It will help clarify the diagnosis and determine the malignancy of the tumor.

Treatment

The treatment is complex. Aimed at eliminating the underlying cause of blockage and treating associated complications.

Therapy aimed at facilitating the breathing process:

the use of diuretics, which help remove excess fluid from the body, and consequently reduce weight;
limiting salt intake;
special ;
hormonal therapy - the use of medications such as Prednisolone.

When an oncological tumor is diagnosed, the patient is given a course of necessary chemotherapy and surgery to remove the tumor.

If a blood clot is detected during diagnosis, surgery or procedures are prescribed to remove it.

In cases where it is impossible to completely remove the compressing tumor due to its ingrowth, a special balloon is installed inside the vessel.

Thanks to it, a person’s blood flow significantly improves.

Forecasts

With timely diagnosis and prompt treatment, patients can have a very favorable prognosis.

When the factor interfering with blood flow is eliminated, there is a significant decrease in the symptoms of complications.

If treatment and consultation with a doctor is delayed for any reason, the outcome can be extremely unfavorable and even fatal.

It is also worth noting that an important role in the success of treatment is its root cause.

If the compression is caused by a malignant tumor, the favorable outcome depends to a large extent on the effectiveness of chemotherapy.

Superior vena cava syndrome is a fairly common disease. Its danger lies in the fact that the existing symptoms do not always indicate the true problem. However, the speed of initiation of treatment in this case plays a decisive role.

It is very important to carefully monitor your health and if signs appear that indicate the possibility of having this disease, you should immediately consult a doctor.

Useful video: Features of the superior vena cava

Cava syndrome, or superior vena cava syndrome, is a complex of specific symptoms of impaired blood circulation in the upper part of the body. Characteristic symptoms include swelling of the neck, cyanosis of the skin and severe dilation of the veins. If these symptoms appear, immediate medical attention is needed.

Kava syndrome is often a concomitant symptom of oncological processes affecting the circulatory and pulmonary systems. Pathology can occur in people of different ages and genders. The syndrome is diagnosed in several percent of cases in pregnant women and children.

Description of the disease and its complications

The superior vena cava is located in the internal space of the middle part of the thoracic cavity. It is surrounded by other tissues: the sternum wall, trachea, bronchi, aorta, lymph nodes. Its function: ensuring the outflow of blood from the lungs, head, and upper torso.

Superior vena cava syndrome is a complex of specific symptoms due to impaired circulation of the upper body

Superior vena cava syndrome is a disruption of normal blood circulation in the upper torso and head. This vessel can be compressed and change its structure during many pathological processes. As a result, the flow of blood from the arms, hands, face, head and neck is disrupted. The blood stagnates.

With superior vena cava syndrome, the danger is high blood pressure. In severe cases, this is 200-250 units in systole, which is life-threatening. Men aged 30 to 60 years are most susceptible to the syndrome.

If left untreated, the patient may experience the following complications:

Various bleedings, which are diagnosed mainly in the upper body. The patient will be bothered by bloody discharge from the nose, eyes, and a cough that may be streaked with blood.
Stagnation of blood can cause sagittal sinus thrombosis.
Impaired blood flow from the head causes swelling of the brain, severe headaches, and increased intracranial pressure.
The most dangerous consequence of the syndrome is hemorrhagic stroke. The effusion of blood into the cranial cavity is very dangerous; in half of the cases, patients experience paralysis and muscle paresis. Death often occurs.

The most dangerous consequence of the syndrome is hemorrhagic stroke

Clinical picture

Thrombosis causes dysfunction of the oculomotor or auditory nerves. It can develop quickly or gradually. In the second case, collaterals have time to form, that is, alternative pathways for blood outflow. At the initial stage, the disease is almost asymptomatic. If the process of blood clot formation develops quickly, the pathology will be severe. The syndrome develops within 10-20 days.

The forced position during rest and sleep is a semi-recumbent position. Sleeping at night becomes impossible without the use of sleeping pills.

Causes of the syndrome

Frequent causes of the development of the syndrome are poor lifestyle and bad habits, which ultimately lead to impaired blood circulation. Less commonly, the development of cava syndrome is provoked by malignant neoplasms:

blood cancer;
brain sarcoma;
oncological processes in the pelvic organs.

Blood cancer can cause this syndrome

The development of the syndrome is often associated with the formation of multiple metastases that penetrate the vena cava. Sometimes the syndrome can occur due to cancer of the lungs, pleura, thyroid gland or as a consequence of post-radiation fibrosis.

Sometimes pathology develops as a result of prolonged catheterization. This provokes the appearance of sclerosis or thrombosis. The occurrence of superior vena cava syndrome in children is often associated with long-term catheterization of the vena cava in oncology.

Superior vena cava syndrome sometimes provokes an increased volume of circulating blood. In pregnant women, it becomes the result of venous stagnation. In the later stages, the uterus puts pressure on the diaphragm and the greater vena cava. A decrease in oxygen levels has a bad effect on a woman’s organs and fetal development slows down. In the last trimester it is provoked by prolonged lying on the back.

Symptoms

As mentioned earlier, few patients pay attention to the symptoms, especially since in the early stages the disease does not have obvious clinical signs. Sometimes there is an increase in blood pressure, which is often attributed to nervous tension.

With superior vena cava syndrome, the clinical picture is complemented by characteristic signs:

the neck becomes swollen;
bloating of veins is observed on the face, neck, forehead;

Swelling in the neck indicates the presence of pathology

the face becomes swollen, small capillaries under the skin burst;
the skin of the face, hands, and neck acquires a characteristic blue tint due to a violation of the outflow of venous blood.

Any of the noticed symptoms requires urgent consultation with a doctor. Call emergency services if symptoms develop very quickly.

With the slow development of superior vena cava syndrome, a person is concerned about:

Breathing disorders. This may be shortness of breath, even at rest, a feeling of lack of air, inability to breathe.
Swallowing disorder. The patient cannot eat or drink.
A cough appears, which gets worse over time. The cough itself is dry, but may be streaked with blood.
Forgetfulness, dizziness, headaches, cramps of the lower and upper extremities.

The severity of symptoms depends on the speed of development and the number of collaterals formed.

Diagnostics

First, the patient must contact a therapist, cardiologist and neurologist for a correct diagnosis. The syndrome is diagnosed using a survey, medical history and instrumental research methods.

One of the types of diagnostics is magnetic resonance therapy

The patient may be prescribed:

X-ray of the chest in 2 projections;
vascular angiography;
CT scan;
magnetic resonance therapy.

The last two methods are the most informative. Often a consultation with an ophthalmologist, ENT specialist, and, if necessary, an oncologist is required.

Bronchoscopy, biopsy of lung tissue and lymph nodes, and thoracoscopy (examination of the pleural cavity) will help in diagnosing superior vena cava syndrome in more detail. This examination reveals the degree of obstruction of the vena cava.

Treatment

In case of secondary superior vena cava syndrome, treatment is symptomatic. It is used together with the main therapy. The purpose of auxiliary treatment is to maintain the body's internal reserves. Conservative therapy includes:

oxygen inhalations;
diuretics;
cortecosteroids.

Diuretics in the treatment of this syndrome

Severe cases of superior vena cava syndrome will require surgery. The patient may be prescribed:

thrombectomy;
resection of the damaged section of the vena cava (a homoimplant is installed in its place);
shunting (bypass of blood outflow);
removal of mediastinal cysts;
stenting of the greater vena cava.

Long-term catheterization will require balloon dilatation of the damaged area.

Prognosis for superior vena cava symptom

With secondary superior vena cava syndrome, good prognosis is impossible without successful primary therapy. Only removing the root cause will help stop the pathological process. The prognosis is unfavorable if there is an oncological factor provoking the syndrome, or if it is acute. During pregnancy, the disease provokes fetal hypoxia.

conclusions

Superior vena cava syndrome is a change caused by long-term compression of the vena cava or its obstruction. Its causes may be different, but successful treatment is possible only when the root cause is completely cured.

Acute development of the syndrome leads to the death of a person. At the first symptoms, the patient urgently needs medical attention.

... can lead to irreversible changes in the brain.
Definition. Superior vena cava syndrome (SVVC) is an emergency condition that is associated with circulatory disorders in the superior vena cava basin and which is caused by the presence of regional venous hypertension of the upper half of the body (through the SVC [lat. - v. cava superior] blood is collected from the upper limbs, organs head and neck, upper chest).

Anatomical and physiological features of the SVC. The SVC is a thin-walled vessel located in the middle mediastinum and surrounded by relatively dense structures such as the chest wall, aorta, trachea and bronchi. Along its entire length, the vein is surrounded by a chain of lymph nodes. For the SVC, low venous pressure is physiological, which, in combination with the above structural features, contributes to mild obstruction of the vein when any structures surrounding it are affected. There are several systems of anastomoses connecting the basins of the inferior and superior vena cava and playing a compensatory role when the patency of the latter is impaired. The most important of these is the azygos vein (v. azigos). Other anastomoses are represented by the internal thoracic, thoracogastric, superficial veins of the chest wall, vertebral veins and the venous plexus of the esophagus (see figure). However, despite the abundance of collaterals, they are not able to completely replace (functionally) the SVC.

Etiology. In the SVC system, the development of venous obstruction is usually associated with various extravascular factors: malignant tumors of the mediastinum and lung cancer should be placed in the first place. Benign intrathoracic tumors are much less likely to cause SVC obstruction. In addition, the cause of superior vena cava syndrome can be aneurysms of the aorta and arteries, mediastinitis of various etiologies. Thrombosis of deep veins of the upper extremities and SVC can be divided into primary and secondary. Primary thrombosis occurs spontaneously or after a sudden load. Secondary thrombosis includes the remaining cases, mainly related to the installation of catheters in a vein. Primary thrombosis occurs with a frequency of 2 cases per 100,000 patients. However, in recent years, the use of indwelling venous access (catheters) for chemotherapy or intravenous nutrition has increased the incidence of deep vein thrombosis. In the first randomized trial, which included 145 cancer patients, the incidence of catheter-related thrombosis was 12% (Kuiper J.W. et al., 2003). Thus, the cause of the development of superior vena cava syndrome is three main processes: compression of the vein from the outside, invasion of the vein by a malignant tumor and thrombosis of the SVC. All occlusion processes divided the SVC into the following groups: compression, stricture, obstruction and mixed.

note! Etiological factors leading to the development of SVPV: A. Tumor neoplasms: malignant: a) bronchogenic cancer of the right lung, b) tumors of the thymus gland, c) tumors of the thyroid gland, d) lymphomas, e) tumors of the pericardium; benign: a) thymomas, b) retrosternal goiter, c) mediastinal cysts, etc. B. Tumor-like processes: aortic aneurysms, damage to the lymph nodes. B. Inflammatory diseases: primary thrombosis of the SVC, fibrous mediastinitis, lymphadenitis, pericarditis.

Pathophysiological features of SVPV. Blockade of venous outflow from the head and upper half of the body causes the following pathophysiological effects in the body: decreased venous return to the right ventricle; decreased cardiac output; systemic hypotension; increased venous pressure in the SVC system, fraught with the risk of thrombosis of cerebral vessels. The result of the last two effects is a decrease in the arterial-venous pressure gradient in the cerebral vessels, which can lead to irreversible changes in the brain. However, since occlusion of the SVC occurs gradually, most patients compensate for these phenomena to a certain extent by developing more or less sufficient collateral outflow along the following routes: through the azygos vein system (provided the latter remains patency); through the system of internal thoracic veins and their anastomoses with the upper and lower epigastric veins into the system of external iliac veins; through the vertebral veins - into the inferior vena cava. Due to the elasticity of the SVC and the low pressure in it, the moment of its invasion is usually preceded by a long period of external compression, during which collateral venous outflow has time to form. Thanks to the compensation mechanisms described above, patients with SVPV die not so much from this syndrome as from other manifestations of the underlying disease. In addition, in lung cancer, patency of the SVC usually persists for a long time, despite invasion. However, only 10 - 20% of patients with malignant SVPV live more than 2 years. The average life expectancy of patients with malignant neoplasms after the onset of SVPV does not exceed 10 months.

Clinic. Manifestations of SVVC are caused by venous hypertension in the area drained by the SVC. Moreover, they are directly dependent on the degree of localization and speed of obstruction, as well as on the degree of development of collaterals. Components of SVVC, in addition to increasing venous pressure, are a slowdown in the speed of blood flow, the development of venous collaterals, and symptoms associated with the disease that caused disruption of the patency of the SVC.

All clinical signs of SVPV are divided by A.N. Bakulev (1967) into two groups:

Symptoms resulting from venous stasis in the superficial and deep veins of the face and neck (classic triad of SVPV): swelling of the face, upper torso and upper extremities (noted most often; in severe cases, swelling can spread to the vocal cords and lead to asphyxia); cyanosis caused by the expansion of venous and narrowing of arterial capillaries; sometimes, against the background of cyanosis of the mucous membranes, an earthy-pale coloration of the facial skin is noted, caused by concomitant lymphostasis; expansion of the saphenous veins of the neck, upper half of the body (the degree of this expansion and its nature are an important sign in the topical diagnosis of the level of occlusion of the SVC and its relationship to the mouth of the azygos vein).

Symptoms caused by venous congestion in the brain: general cerebral symptoms: headache, shortness of breath with attacks of suffocation of central origin, resulting from increased intracranial pressure; long-term disorders may be aggravated by swelling of the vocal cords and larynx; symptoms associated with a violation of cortical neuroregulation: drowsiness, emotional fatigue, attacks of dizziness with loss of consciousness - are signs of chronic brain hypoxia that develops as a result of circulatory disorders (one of the severe manifestations of a disorder of cortical neuroregulation can be confusion and auditory hallucinations); symptoms associated with dysfunction of the cranial nerves: tinnitus, hearing loss and diplopia - caused by a disorder of auditory and oculomotor nerves; lacrimation, decreased visual acuity - increased intraocular and intracranial pressure.

For a more complete description of the patient’s condition and the reliability of the clinical picture, a 3rd group of symptoms caused by the underlying disease should be distinguished: weight loss, cough, hemoptysis, etc.

In addition, one of [ !!! ] striking clinical symptoms of a disorder of venous outflow are nasal, esophageal and tracheobronchial bleeding resulting from rupture of thinned vein walls. Moreover, in contrast to portal hypertension, with occlusion of the SVC, varicose veins are localized in the proximal parts of the esophagus. During physical activity, rapid fatigue sets in, the hands get tired especially quickly, and performing even light physical work becomes impossible due to a rush of blood to the head. Palpitations, pain in the heart area, and a feeling of compression behind the sternum are caused by impaired blood supply to the myocardium and swelling of the mediastinal tissue.

note! The clinical course of SVPV can be acute or slowly progressive. The patient's complaints are extremely varied: headache, nausea, dizziness, changes in appearance, hoarseness, cough, dysphagia, chest pain, difficulty breathing, shortness of breath, drowsiness, fainting, convulsions. A physical examination reveals the most characteristic signs of SVPV: dilation, swelling of the veins of the neck, chest wall and upper extremities, swelling of the face, neck or upper shoulder girdle, cyanosis or plethora of the face (plethora), tachypnea. It should, however, be borne in mind that in many patients who have developed collateral venous outflow, the SVPV pattern may be blurred; in some cases, patients do not even present a single characteristic complaint. In the physical diagnosis of SVPV in doubtful cases, the so-called Pemberton maneuver (the patient is asked to raise both arms up and remain in this position for some time: in the case of occlusion of the SVC, characteristic physical signs appear: cyanosis of the skin of the face and neck, swelling of the jugular veins, injection of conjunctival vessels, etc.) or other such simple tests (the appearance of signs of SVPV can be seen by asking the patient to do 15 - 20 quick forward bends of the torso).

Diagnostics. Clinical findings and physical examination may be sufficient to diagnose SVPV. Chest X-ray in frontal and lateral projections and tomography are indicated for all patients in cases of emergency or if there is a suspicion of obstruction of the superior vena cava. X-ray examination allows us to identify the pathological process in the mediastinum, the extent of its spread and determine the boundaries for subsequent radiation therapy. In case of SVPV, it is advisable to perform X-ray computed tomography (CT, including multislice CT) with contrast, which makes it possible to clarify the contours of the tumor process, the extent of damage to the mediastinal lymph nodes and identify the presence of pulmonary emboli. In some clinical situations, Doppler ultrasound examination of the carotid or supraclavicular veins is useful for the purpose of differential diagnosis between thrombosis and external obstruction. Injection of radiocontrast or other substances into the vein of the affected limb is not recommended due to the high risk of extravasation. However, in rare cases, venography is performed to identify the location and degree of obstruction of the superior vena cava. Phlebography turns out to be useful for differential diagnosis of the vascular and extravascular nature of the lesion, resolving the issue of operability, and determining the extent of the affected segment. Magnetic resonance (MR) imaging has proven its capabilities in the diagnosis of vascular abnormalities. MR venography can be performed without the introduction of a contrast agent, for example, using the time-of-flight (TOF) method or using a phase contrast sequence. Another MR technique can detect blood clots without injecting a contrast agent. Direct visualization of the thrombus is possible because the blood stream has a high concentration of methemoglobin, which is clearly visible on T1-weighted images. The method is sensitive to fresh thromboses, which can be distinguished from old ones. There are two methods of contrast-enhanced MR venography. The indirect 3D method requires an injection of gadolinium contrast into a vein; they also use the subtraction method - first an image mask is obtained, then this mask is subtracted from the subsequent series of images.

Principles of therapy. Optimal treatment depends on the underlying cause of SVEP and the rate at which symptoms progress. In almost half of cases, SVPV develops before diagnosis. It must be emphasized that determining the initial process that caused this condition is the key to successful therapy, and only in case of severe disorders and in a life-threatening condition is it permissible to begin treatment without establishing the main diagnosis (it must be remembered that more than 50% of cases of SVPV are caused by potentially curable diseases such as small cell lung cancer, non-Hodgkin's lymphoma and germ cell tumors).

Emergency symptomatic measures are aimed at saving the patient’s life; they are necessary to ensure the flow of air into the lungs, eliminate obstruction of the superior vena cava and compression of the mediastinal organs. In addition to rest, elevated position, oxygen therapy, tracheostomy, intubation, and administration of anticonvulsants may sometimes be required. The use of diuretics (furosemide, mannitol) and corticosteroids is indicated. It is recommended to administer hydrocortisone from 100 to 500 mg intravenously, followed by a dose reduction every 6 to 8 hours, taking into account the clinical picture, or to prescribe prednisolone 60 to 90 mg intravenously, then 40 to 60 mg per day orally. It should be noted that the effectiveness of the use of glucocorticoids in this situation has not been proven in clinical studies, and recommendations for their use are based on experience in clinical practice. For SVC thrombosis, treatment with anticoagulants or fibrinolytic drugs is indicated. But these drugs should not be prescribed routinely, unless phlebography reveals SVC thrombosis or there are no signs of improvement with other treatment methods.

In terms of surgical strategy, several fundamental approaches to solving the problem of restoring venous outflow in the SVC system have been formed: external decompression; bypass surgery: (a) internal (intrathoracic), (b) external (extrathoracic); thrombectomy; plastic surgery; extensive resections followed by reconstruction; percutaneous endovascular angioplasty and endoprosthetics.

Literature: 1 . article “Superior vena cava syndrome” S. A. Protsenko, A.V. Novik, GUN Research Institute of Oncology named after. prof. N.N. Petrova Roszdrav, St. Petersburg (Practical Oncology, T. 7, No. 2, 2006); 2 . lecture “Compression syndrome of the superior vena cava - diagnosis and treatment tactics” V.V. Fastakovsky, A.V. Vazhenin, A.A. Fokin, A.A. Lukin; Chelyabinsk Regional Oncology Center; Ural State Medical Academy of Additional Education; Problem Research Laboratory “Radiation Oncology and Angiology” SUNTSRAM, Chelyabinsk (Siberian Journal of Oncology, 2004, No. 4); 3 . article “Preoperative assessment of the vena cava using computed tomography” by M.A. Karaseva; FGBNU Scientific Center for Cardiovascular Surgery named after. A.N. Bakulev”, Moscow, Russian Federation (Creative Cardiology, No. 2, 2015); 4 . article “Surgical correction of superior vena cava syndrome” by V.V. Boyko, A.G. Krasnoyaruzhsky, P.I. Korzh; State Institution "Institute of General and Emergency Surgery of the Academy of Medical Sciences of Ukraine", Kharkov (Emergency Medicine, No. 3 (34), 2011); 5 . article “Prosthesis of the superior vena cava for malignant breast tumors: literature review and experience of 33 operations” Victor A. TARASOV, Professor, Head of the Department of Thoracic Surgery, Medical Academy of Postgraduate Education, St. Petersburg, Russia; Evgeny S. POBEGALOV, Associate Professor, Department of Thoracic Surgery, Medical Academy of Postgraduate Education, St.Petersburg, Russia Vladimir; V. STAVROVIETSKIY, Chief of the Thoracic Surgery Unit, Municipal Hospital No. 26, St.Petersburg, Russia; Yuriy K. SHAROV, Associate Professor, Department of Thoracic Surgery, Medical Academy of Postgraduate Education, St. Petersburg, Russia; Maria V. VINOGRADOVA, Assistant Professor, Department of Thoracic Surgery, Medical Academy of Postgraduate Education, St. Petersburg, Russia.

At the moment, no clear treatment regimen for inferior vena cava syndrome has been developed. In most situations, conservative therapy is used with the mandatory prescription of drugs that affect blood clotting, both direct and indirect.

When prescribing medication, one should take into account the duration of the disease, which is practically impossible to determine in this syndrome. It is known that antithrombotic agents have the greatest effect only at the initial stages of blockage formation.

Maintaining normal functioning of the kidneys and liver is also important.

	Mode of application	Side effects	special instructions
Fraxiparine	Used before and after surgery, usually 0.3 ml by injection subcutaneously.	Bleeding, subcutaneous hematomas, hemorrhages.	The drug is not used intramuscularly.
Warfarin	Most often taken orally, from 2 to 10 mg per day.	Bleeding, hemorrhages, anemia, dermatitis, headache.	During the therapeutic course, the degree of blood clotting should be monitored.
Streptokinase	Means for infusion therapy. The dose of the drug is selected only individually.	Bleeding gums, hematomas, redness of the skin, internal bleeding.	Prescribed with caution for liver and kidney diseases, as well as in old age.
Refortan	Administered intravenously, from 10 to 1000 ml per day.	Vomiting, itchy skin, pain in the lower back.	During treatment, renal function must be monitored.
Chime	Take 75 mg three times a day.	Rapid heartbeat, dyspepsia, thrombocytopenia, tinnitus, feeling of weakness.

The main vitamins that help strengthen the venous walls are tocopherol and ascorbic acid. Foods rich in these vitamins reduce the likelihood of blood clots and blockage of the inferior vena cava.

Tocopherol (b. E) is present in beans, cereals, liver, broccoli, and also in vegetable oils.

Ascorbic acid is found in sufficient quantities in berries, grapes, kiwi and citrus fruits.

In addition, it is advisable to eat foods rich in carotene, rutin, as well as microelements such as copper, iron and zinc. To do this, you need to cook dishes from cabbage, nuts, red fruits and vegetables, and meat more often.

Physiotherapeutic treatment for inferior vena cava syndrome is used extremely rarely. It is possible to prescribe physical therapy and manual therapy (according to indications).

Homeopathy has been treating diseases such as inferior vena cava syndrome for many years. In this case, homeopathic doctors advise using products that strengthen vascular walls, regulate blood circulation and improve blood properties. Treatment tactics are usually determined depending on the disease or condition that may have caused the blockage of the vein.

Recently, the following homeopathic medicines have been of interest:

Crotalus (striped rattlesnake) – Heel brand products are used, such as Crotalus-Heel and Crotalus-Heel forte, in dilutions of 12, 30, 200;
Aesculus (horse chestnut extract) - prescribed in the form of injections (preparations Aesculus Ingeel and Aesculus Ingeel Forte), or in the form of solutions of Aesculus Heel, Arnica Heel or Arteria Heel, 10-15 drops three times a day;
Vipera berus (a drug from viper venom) - used in the form of injections of the drug Vipera berus Ingeel. Dosage D–15, 30, 200.

In addition, drugs prepared on the basis of coagulation factors can be prescribed: thrombin, fibrinogen, fibrin, etc. In the future, it is recommended to use Aorta suis Ingeel, Arteria suis Injeel, Vena suis Ingeel, which are made from thrombotic material.

Surgical treatment is prescribed for thrombosis of the inferior vena cava:

in the presence of thromboembolism of the lumen of the inferior vena cava;
when the venous vessels of the liver or kidneys are blocked with impaired organ function;
with coarctation of the inferior vena cava;
with “long-standing thrombosis” (more than 14-20 days).

The operation is performed under intubation anesthesia using muscle relaxant drugs. The surgeon performs a median laparotomy, thoracophrenolumbotomy, or various types of extraperitoneal access. The trunk of the inferior vena cava is isolated, clamps are applied and a radical removal of a blood clot or other cause that interferes with normal blood circulation in the vessel is performed. If a narrowed area is detected, balloon dilation is performed with further stenting.

Traditional treatment

In consultation with your doctor, you can use the following traditional recipes:

Take 15 g of verbena leaf and brew it in a glass of boiling water. Take 1 tbsp. l. every hour until the condition improves.
Drink a third of a glass of infusion from St. John's wort, plantain, dried herb, coriander, licorice rhizome and string. To prepare the infusion, you will need 2 tbsp. l. an equivalent mixture of the listed plants and 220 ml of boiling water. The medicine is taken half an hour before meals.
Take ground nutmeg with regular warm water or tea.
Take 0.3 g of mumiyo orally twice a day, or in combination with honey and milk. Duration of treatment – up to 25 days in a row.

Herbal treatment often includes complex multi-component recipes.