Obstruction of Large Veins

Iliofemoral region ( phlegmasia alba et coerulea dolens ), v. cava inferior , axilosubclavian region, v. cava superior – Perthes syndrome ( blue mask ).

Inferior Vena Cava Obstruction

Causes

Thrombosis proceeding from the iliac region (high risk of pulmonary embolism). Also venostasis in right heart insufficiency. Ongoing thrombosis of the hepatic veins (Budd-Chiari syndrome). Tumor ingrowth – Grawitz, hepatocellular carcinoma. Complications of catheterization. Post-operative (liver transplant...).

Clinical manifestations

Pains in the abdomen, lower abdomen, lumbar region, sometimes shoot to DK. Venostasis of the liver (hepatomegaly), ascites , swelling of both DK. Renal insufficiency.

Diagnostics

Cavography.

Treatment

Dilation, event by inserting a stent. The operation is very risky (necessary circulatory arrest in deep hypothermia).

Obstructions of the axillosubclavian region

Causes

Most often as a complication of CVK, pacemaker insertion, with TOS or after excessive exertion or sports (tennis...), pulmonary embolism (very rare).

Clinical Manifestation

Swelling, light cyanosis, filling of superficial veins HK.


Diagnostics

using ultrasound

Treatment

Conservative (elevation, cold compresses, antiphlogistics for lighter forms). Local fibrinolysis with subsequent heparinization is optimal. Surgical treatment – ​​thrombectomy.

Superior Vena Cava Syndrome

Causes

Malignant mediastinal tumors ( bronchogenic carcinoma, non-Hodgkin's lymphoma ), or thrombosis complicate an established CVK.

Clinical manifestations

Swelling of the neck, face and HK, cyanosis, changes from brain edema (behavior and consciousness disorders, papilledema), often shortness of breath .

Diagnostics

Phlebography (after managing the acute condition, look for the cause - tumor).

Treatment

  • Thrombosis – remove the catheter, fibrinolysis with subsequent anticoagulant therapy.
  • Signs of brain edema – corticoids , mannitol.
  • Tumor - radiotherapy.
  • Surgical solution – bypass , stent insertion.

Source

  • BENEŠ, Jiří. Surgery Questions  [online]. ©2007. [feeling. 6/28/2010]. <jirben2.chytrak.cz/materialy/chira/cevni.doc>.