The following are key points to remember from a state-of-the-art review on superior vena cava (SVC) syndrome:

1. SVC syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC.
2. SVC syndrome is caused by obstruction of blood flow through the SVC and usually secondary to malignancy; however, recently, device-related SVC syndrome is increasing.
3. Contrast-enhanced computed tomography (CT) scanning provides optimal visualization of the SVC and can localize the extent of venous blockage, differentiate thrombosis from extrinsic compression, and identify collateral pathways.
4. The management of patients with life-threatening SVC syndrome is evolving from radiation therapy to endovascular therapy as the first-line treatment.
5. The treatment approach in patients with SVC syndrome should be multidisciplinary and include oncology, pulmonology, radiology, surgery, and vascular and endovascular specialists.
6. Although there are no prospective randomized studies of endovascular therapy in treatment of SVC syndrome, observational data suggest a robust technical success rate of 80% to 98%, with symptomatic relief in >90% of patients.
7. The Food and Drug Administration recently approved dedicated venous stents (Venovo [Bard, Minneapolis, MN] and Vici [Boston Scientific, Natick, MA]), but data regarding the use of these new stents in SVC syndrome are not yet available.
8. Currently, for cases of SVC obstruction with significant thrombosis, systemic anticoagulation is the standard of care, both before and after revascularization. However, in the absence of notable thrombosis, the utility of long-term anticoagulation or antithrombotic therapy has not been well established.
9. In patients with nonthrombotic obstruction, dual antiplatelet therapy with aspirin and a thienopyridine is commonly administered for a month or longer after endovascular revascularization, although the evidence supporting this is lacking to date.
10. Technical advances in dedicated venous and/or covered stent technology may lead to further improvement in durability of endovascular treatment and improved outcomes.

Clinical Topics: Anticoagulation Management, Cardiac Surgery, Cardio-Oncology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Interventions and Vascular Medicine, Computed Tomography, Nuclear Imaging

Keywords: Anticoagulants, Aspirin, Cardiac Surgical Procedures, Cardiotoxicity, Endovascular Procedures, Fibrinolytic Agents, Myocardial Revascularization, Neoplasms, Platelet Aggregation Inhibitors, Pulmonary Medicine, Radiography, Secondary Prevention, Stents, Superior Vena Cava Syndrome, Thrombosis, Tomography, X-Ray Computed, Vascular Diseases, Vena Cava, Superior

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