BENIGN SUPERIOR VENA-CAVA SYNDROMES

Superior vena cava syndromes are uncommon and usually caused by malign ant diseases. In about 20% of the cases however, the cause is benign. Besides chronic mediastinitis, a growing number of cases are reported of thrombosis resulting from endovenous devices (central catheters, pa cemaker leads...). Onset is often slow and insidious, good tolerance i n the early stages being explained by the development of an effective collateral circulation. Bibrachial phlebography is still the reference exploration, but computed tomography and magnetic resonance imaging a re contributive to diagnosis. Symptoms usually regress after medical t reatment, sometimes requiring thrombolysis, however, in 10% of the pat ients, major functional impairment may require bypass surgery (autolog ous graft or endoprosthesis) or transluminal angioplasty. There is sti ll some debate as to the precise indications for each method, but angi oplasty, used recently, appears to be the most interesting technique f or a disease in which prognosis is almost always favorable.