Emergent Endovascular Therapy for Malignant Superior Vena Cava Syndrome Complicated by Extensive Central Venous Thrombosis: A Case Report

Background. Superior vena cava (SVC) syndrome is a potentially life-threatening condition caused by obstruction of venous return through the SVC, most commonly due to malignancy. Although endovascular therapy (ET) has emerged as an effective treatment for rapid symptom relief, malignant SVC syndrome complicated by extensive central venous thrombosis and respiratory failure remains a high-acuity presentation requiring urgent intervention. This case highlights the role of emergent ET as a life-saving bridge to definitive oncologic treatment in critically ill patients. Case. A 58-year-old male with squamous cell carcinoma of the lung presented with acute respiratory failure, facial and upper extremity swelling, and cyanosis concerning for SVC syndrome. Imaging demonstrated near-complete SVC obstruction with extensive thrombus involving the brachiocephalic and subclavian veins. Emergent ET was performed using mechanical thrombectomy, balloon angioplasty, and SVC stent placement. The intervention restored venous patency and resulted in rapid clinical improvement and extubation within 48 hours. The patient was discharged in stable condition to pursue outpatient oncologic treatment. Conclusion. This case demonstrates the effectiveness of ET in the emergent management of malignant SVC syndrome complicated by extensive central venous thrombosis. Prompt endovascular intervention can rapidly restore venous patency, relieve symptoms, and serve as a life-saving bridge to definitive oncologic therapy in critically ill patients.