Endovenous and Operative Treatment of Superior Vena Cava Syndrome Manju Kalra, MBBS*, Indrani Sen, MBBS, Peter Gloviczki, MD INTRODUCTION: NATURE OF THE PROBLEM In the United States each year about 15,000 patients develop symptoms of venous congestion of the head and neck due to occlusion of the superior vena cava (SVC) or innominate veins. Metastatic lung cancer with mediastinal lymphadenopathy and primary mediastinal malignancy is the most common cause (60% of cases). 1,2 Nonmalignant causes are, however, increasing because of the more frequent use of central venous lines and cardiac pacemakers. Other causes include mediastinal fibrosis; granulomatous fungal disease, such as histoplasmosis; previous radiation to the mediastinum; retrosternal goiter; and aortic dissection. Signs and symptoms The authors have nothing to disclose. Mayo Clinic College of Medicine, 200 2nd Street SW, Rochester, MN 55905, USA * Corresponding author. E-mail address: kalra.manju@mayo.edu KEYWORDS  Superior vena cava  Endovenous stenting  SVC bypass  Spiral saphenous  Femoral vein KEY POINTS  The incidence of superior vena cava (SVC) syndrome is increasing secondary to venous thrombosis associated with the escalating use of central venous lines and cardiac pacemakers.  Endovenous treatment, previously reserved for malignant SVC obstruction, if technically feasible, has become the first line of treatment of all causes of severely symptomatic SVC syndrome.  Balloon and self-expanding stents have been used, depending on cause and lesion char- acteristics, with recent introduction of covered stents for this indication.  Open surgical treatment, though significantly more invasive, has an important role to play in patients with benign SVC syndrome in whom endovenous treatment has either been technically unsuccessful or has eventually failed.  Ideal conduits for surgical reconstruction of the SVC include spiral saphenous vein graft, femoral vein, and expanded polytetrafluoroethylene, which only perform well in the long-term for short reconstructions limited to within the mediastinum. Surg Clin N Am 98 (2018) 321–335 https://doi.org/10.1016/j.suc.2017.11.013 surgical.theclinics.com 0039-6109/18/ª 2017 Elsevier Inc. All rights reserved.