Veins of the systemic circulation. The system of the superior vena cava The superior vena cava consists of

The superior and inferior vena cava are among the largest vessels human body, without which the proper functioning of the vascular system and the heart is impossible. Compression, thrombosis of these vessels are fraught not only with unpleasant subjective symptoms, but also with serious disorders of blood flow and cardiac activity, therefore, they deserve the close attention of specialists.

The causes of compression or thrombosis of the vena cava are very different, therefore specialists of various profiles face pathology - oncologists, phthisiopulmonologists, hematologists, obstetricians-gynecologists, cardiologists. They treat not only the consequence, that is, the vascular problem, but also the cause - diseases of other organs, tumors.

There are more men among patients with lesions of the superior vena cava (SVC), while the inferior vena cava(NPV) is more often affected in the female half due to pregnancy and childbirth, obstetric and gynecological pathology.

Doctors to improve venous outflow suggest conservative treatment, but it is often necessary to resort to surgical operations especially in thrombosis.

Anatomy of the superior and inferior vena cava

Many people remember from a high school anatomy course that both vena cava carry blood to the heart. They have a rather large lumen in diameter, where all the venous blood flowing from the tissues and organs of our body is placed. Heading towards the heart from both halves of the body, the veins connect to the so-called sinus, through which blood enters the heart, and then goes to the pulmonary circle for oxygen saturation.

System of inferior and superior vena cava, portal vein - lecture

superior vena cava

superior vena cava system

The superior vena cava (SVC) is a large vessel about two centimeters wide and about 5-7 cm long, carrying blood away from the head and upper half of the body. and located in the anterior part of the mediastinum. It is devoid of valves and is formed by joining the two brachiocephalic veins behind where the first rib joins the sternum on the right. The vessel almost vertically goes down to the cartilage of the second rib, where it enters the heart sac, and then, in the projection of the third rib, enters the right atrium.

In front of the SVC is the thymus and parts of the right lung, on the right it is covered with a mediastinal sheet of the serous membrane, on the left it adjoins the aorta. The back of it is anterior to the root of the lung, behind and slightly to the left is the trachea. The vagus nerve passes through the tissue behind the vessel.

The SVC collects blood flows from the tissues of the head, neck, arms, chest and abdominal cavity, esophagus, intercostal veins, and mediastinum. The unpaired vein flows into it from behind and the vessels carrying blood from the mediastinum and pericardium.

Video: superior vena cava - education, topography, inflow

inferior vena cava

The inferior vena cava (IVC) is devoid of valvular apparatus and has the largest diameter among all venous vessels. It begins by joining two common iliac veins, its mouth is located more to the right than the zone of branching of the aorta into the iliac arteries. Topographically, the beginning of the vessel is in the projection intervertebral disc 4-5 lumbar vertebrae.

The IVC is directed vertically upwards to the right of the abdominal aorta, behind it actually lies on the psoas major muscle of the right half of the body, in front it is covered with a sheet of serous membrane.

Going to the right atrium, the IVC is located behind the duodenum, the root of the mesentery and the head of the pancreas, enters the liver groove of the same name, and there it connects with the hepatic venous vessels. Further along the path of the vein lies the diaphragm, which has its own opening for the inferior vena cava, through which the latter goes up and goes in the posterior mediastinum, reaches the heart shirt and connects to the heart.

IVC collects blood from the veins of the lower back, lower diaphragmatic and visceral branches coming from internal organs- ovarian in women and testicular in men (the right ones flow directly into the vena cava, the left ones - into the renal vein on the left), renal (go horizontally from the gates of the kidneys), right adrenal vein (the left one is connected immediately to the renal), hepatic.

The inferior vena cava takes blood from the legs, pelvic organs, abdomen, diaphragm. The fluid moves along it from the bottom up, to the left of the vessel, the aorta lies for almost its entire length. At the point of entry into the right atrium, the inferior vena cava is covered by the epicardium.

Video: inferior vena cava - education, topography, inflow

Pathology of the hollow veins

Changes in the vena cava are most often secondary and associated with a disease of other organs, therefore they are called the syndrome of the superior or inferior vena cava, indicating the dependence of the pathology.

superior vena cava syndrome

The syndrome of the superior vena cava is usually diagnosed among the male population, both young and old, average age patients - about 40-60 years.

The basis of the syndrome of the superior vena cava is compression from outside or thrombus formation due to diseases of the mediastinum and lungs:

• bronchopulmonary cancer;
• Lymphogranulomatosis, an increase in the lymph nodes of the mediastinum due to metastases of cancer of other organs;
• infectious and inflammatory processes(tuberculosis, with fibrosis);
• Thrombosis against the background of a long-term catheter or electrode in the vessel during pacing.

compression of the superior vena cava by a lung tumor

When a vessel is compressed or its patency is impaired, there is a sharp difficulty in the movement of venous blood from the head, neck, arms, shoulder girdle to the heart, resulting in venous congestion and serious hemodynamic disorders.

The severity of the symptoms of the superior vena cava syndrome is determined by how quickly the blood flow was disturbed and how well the bypass pathways of the blood supply are developed. With a sudden overlap of the vascular lumen, the phenomena of venous dysfunction will increase rapidly, causing acute disorder blood circulation in the system of the superior vena cava, with a relatively slow development of pathology (enlarged lymph nodes, growth of a lung tumor) and the course of the disease will be slowly increasing.

Symptoms accompanying the expansion or thrombosis of the SVC "fit" into the classic triad:

1. Swelling of the tissues of the face, neck, hands.
2. Blueness of the skin.
3. Expansion of the saphenous veins of the upper half of the body, arms, face, swelling of the venous trunks of the neck.

Patients complain of shortness of breath even in the absence of physical activity, the voice may become hoarse, swallowing is disturbed, there is a tendency to choking, coughing, pain in the chest. A sharp increase in pressure in the superior vena cava and its tributaries provokes ruptures of the walls of blood vessels and bleeding from the nose, lungs, and esophagus.

A third of patients are faced with laryngeal edema against the background of venous stasis, which is manifested by noisy, stridor breathing and dangerous asphyxia. An increase in venous insufficiency can lead to cerebral edema, a deadly condition.

To alleviate the symptoms of pathology, the patient seeks to take a sitting or semi-sitting position, in which the outflow of venous blood towards the heart is somewhat facilitated. In the supine position, the described signs of venous congestion are intensified.

Violation of the outflow of blood from the brain is fraught with symptoms such as:

• Headache;
• convulsive syndrome;
• Drowsiness;
• Violations of consciousness up to fainting;
• Decreased hearing and vision;
• Bulging eyes (due to swelling of the tissue behind the eyeballs);
• lacrimation;
• Hum in head or ears.

To diagnose the syndrome of the superior vena cava, X-ray of the lungs is used (it allows to identify tumors, changes in the mediastinum, from the side of the heart and pericardium), computed and magnetic resonance imaging (neoplasms, examination of lymph nodes), phlebography is indicated to determine the localization and degree of blockage of the vessel.

In addition to the studies described, the patient is referred to an ophthalmologist, who will detect congestion in the fundus and swelling, for an ultrasound examination of the vessels of the head and neck to assess the effectiveness of outflow through them. In case of pathology of the organs of the chest cavity, a biopsy, thoracoscopy, bronchoscopy and other studies may be necessary.

Before the cause of venous stasis becomes clear, the patient is prescribed a diet with a minimum content of salt, hormones, and the drinking regimen is limited.

If the pathology of the superior vena cava is caused by cancer, then the patient will undergo courses of chemotherapy, radiation, and surgery in an oncological hospital. In case of thrombosis, a variant of surgical restoration of blood flow in the vessel is prescribed and planned.

Absolute indications for surgical treatment with damage to the superior vena cava - this is an acute obstruction of the vessel by a thrombus or a rapidly growing tumor with insufficient collateral circulation.

stenting of the superior vena cava

In case of acute thrombosis, they resort to the removal of a thrombus (thrombectomy), if the cause is a tumor, it is excised. In severe cases, when the wall of the vein is irreversibly changed or has grown into a tumor, it is possible to resect a section of the vessel with the replacement of the defect with the patient's own tissues. One of the most promising methods is considered to be a vein in the place of greatest difficulty in blood flow (balloon), which is used for tumors and cicatricial deformities of the mediastinal tissues. As a palliative treatment, bypass surgery is used, aimed at ensuring the discharge of blood, bypassing the affected area.

inferior vena cava syndrome

The syndrome of the inferior vena cava is considered a rather rare pathology, and it is usually associated with blockage of the lumen of the vessel by a thrombus.

clamping of the inferior vena cava in pregnant women

A special group of patients with impaired blood flow through the vena cava are pregnant women who have prerequisites for squeezing the vessel by the enlarging uterus, as well as changes in blood coagulability towards hypercoagulability.

According to the course, nature of complications and outcomes, thrombosis of the vena cava is one of the most severe types of venous circulation disorders, after all, one of the largest veins of the human body is involved. Difficulties in diagnosis and treatment can be associated not only with the limited use of many research methods in pregnant women, but also with the rarity of the syndrome itself, about which not much has been written even in specialized literature.

The causes of the syndrome of the inferior vena cava can be thrombosis, which is especially often combined with the femoral and iliac veins. Almost half of the patients have an ascending pathway of thrombosis.

Violation of blood flow through the vena cava can be caused by targeted ligation of the vein in order to avoid embolism of the pulmonary arteries in case of vein damage lower extremities. Malignant neoplasms retroperitoneal, abdominal organs provoke blockage of the IVC in about 40% of cases.

During pregnancy, conditions are created for compression of the IVC by an ever-increasing uterus, which is especially noticeable when there are two or more fetuses, a diagnosis of polyhydramnios is established, or the fetus is large enough. According to some reports, signs of impaired venous outflow in the system of the inferior vena cava can be detected in half of expectant mothers, but symptoms occur only in 10% of cases, and pronounced forms - in one woman out of 100, while a combination of pregnancy with pathology of hemostasis and somatic diseases.

The pathogenesis of IVC syndrome consists in a disorder in the return of blood to the right side of the heart and its stagnation in the lower half of the body or legs. Against the background of overflow of the venous lines of the legs and pelvis with blood, the heart experiences a lack of it and is not able to transport the required volume to the lungs, resulting in hypoxia and a decrease in ejection arterial blood into the arterial line. The formation of bypass ways of outflow of venous blood contributes to the weakening of symptoms and thrombotic lesions, and compression.

The clinical signs of thrombosis of the inferior vena cava are determined by its degree, the rate of blockage of the lumen and the level where the occlusion occurred. Depending on the level of obstruction, thrombosis is distal, when a fragment of the vein is affected below the place where the renal veins enter it, in other cases, the renal and hepatic segments are involved.

The main signs of thrombosis of the inferior vena cava are:

1. Pain in the abdomen and lower back, the muscles of the abdominal wall may be tense;
2. Swelling of the legs, groin, pubis, abdomen;
3. Cyanosis below the zone of occlusion (legs, lower back, abdomen);
4. Perhaps the expansion of the saphenous veins, which is often combined with a gradual decrease in edema as a result of the establishment of collateral circulation.

With renal thrombosis, there is a high probability acute insufficiency kidneys due to severe venous plethora. At the same time, the violation of the filtration capacity of the organs progresses rapidly, the amount of urine formed decreases sharply up to its complete absence (anuria), the concentration of nitrogenous metabolic products (creatinine, urea) increases in the blood. Patients with acute kidney failure Against the background of vein thrombosis, they complain of back pain, their condition progressively worsens, intoxication increases, and impaired consciousness by the type of uremic coma is possible.

Thrombosis of the inferior vena cava at the confluence of the hepatic tributaries manifests itself severe pain in the abdomen - in the epigastrium, under the right costal arch, jaundice, the rapid development of ascites, intoxication, nausea, vomiting, and fever are characteristic. In acute vascular occlusion, symptoms appear very quickly, and there is a high risk of acute liver or hepatic-renal failure with high mortality.

Blood flow disorders in the vena cava at the level of the hepatic and renal tributaries are among the most severe types of pathology with high mortality. even in the face of opportunity modern medicine. Occlusion of the inferior vena cava below the place of branching of the renal veins proceeds more favorably, since the vital organs continue to perform their functions.

When closing the lumen of the inferior vena cava, the lesion of the legs is always bilateral. Typical symptoms of pathology can be considered soreness, affecting not only the limbs, but also the groin area, abdomen, buttocks, as well as swelling, evenly spreading throughout the leg, front wall of the abdomen, groin and pubis. Expanded venous trunks become visible under the skin, taking on the role of bypass routes of blood flow.

More than 70% of patients with thrombosis of the inferior vena cava suffer from trophic disorders in soft tissues legs. Against the background of severe edema, non-healing ulcers appear, often they are multiple, and conservative treatment does not bring any result. In most male patients with lesions of the inferior vena cava, stagnation of blood in the pelvic organs and scrotum causes impotence and infertility.

In pregnant women, with compression of the vena cava from an extra-growing uterus, symptoms may be little or absent with adequate collateral blood flow. Signs of pathology appear by the third trimester and may consist of swelling of the legs, severe weakness, dizziness and fainting in the supine position, when the uterus actually lies on the inferior vena cava.

In severe cases during pregnancy, the syndrome of the inferior vena cava can be manifested by episodes of loss of consciousness and severe hypotension, which affects the development of the fetus in the uterus, which it experiences.

To detect occlusions or compression of the inferior vena cava, phlebography is used as one of the most informative diagnostic methods. It is possible to use ultrasound, MRI, blood tests for coagulation and urinalysis are required to exclude renal pathology.

Video: thrombosis of the inferior vena cava, floating thrombus on ultrasound

Treatment of inferior vena cava syndrome can be conservative in the form of prescription, thrombolytic therapy, correction of metabolic disorders by infusion medicinal solutions, however, with massive and highly located occlusions of the vessel, surgery is indispensable. Performed, resections of sections of blood vessels, bypass operations aimed at dumping blood in a bypass way, bypassing the place of blockage. For the prevention of thromboembolism in the system pulmonary artery special ones are installed.

Pregnant women with signs of vena cava compression are advised to sleep or lie only on their side, exclude any exercises in the supine position, replacing them with walking and water procedures.

The circulatory system should be attributed to the most important component human body. The superior vena cava is an integral part of this system. Blood plays the role of a nutrient for our body, it takes part in all important metabolic reactions.

Human anatomy, as topography shows, includes vessels and veins in the circulatory system, through which important elements are delivered. For this reason, for the whole circuit to work perfectly, even a small capillary must perform its functions perfectly.

Only the heart matters

In order to find out what anatomy and topography of the heart, you need to study its structure a little. The human heart consists of 4 chambers, divided by a partition into 2 halves: right and left. Each half contains a ventricle and an atrium. Another separating element is the septum, which takes part in pumping blood.

The complex topography of the venous apparatus of the heart is due to four veins: two channels (the veins of the system of the superior vena cava) are directed to the area of ​​​​the right atrium, at the same time two pulmonary ones flow into the left.

In addition, the circulatory system also includes the aorta and the pulmonary trunk. Through the aorta, branched from the mouth of the left ventricle, the blood flow enters the specified organs and tissues of the human body (except for the lungs). The blood path runs from the right ventricle through the pulmonary artery through the pulmonary circulation, which nourishes the alveoli of the lung and bronchi. This is how blood circulates in our body.

Venous apparatus of the heart muscle

Since our heart has a fairly compact size, the vascular area also consists of small but thick-walled veins. In front of the mediastinum of the heart is a vein formed by the union of the left and right brachiocephalic veins. This vein is called the superior vena cava, it belongs to the systemic circulation. Its dimensions in diameter can be up to 23-25 ​​mm, and in length from 4.8 to 7.5 cm.

As the topography indicates, the mouth of the superior vena cava is located at a sufficient depth in the pericardial cavity. On the left side of the vessel is the ascending aorta, and on the right side is the mediastinal pleura. At a small distance behind it, the anterior surface of the root section of the right lung is visible. Such a dense interposition threatens with compression, which leads to poor blood circulation.

The superior vena cava adjoins the right atrium at the level of the second rib and is filled with blood flow from the neck, head, upper zones chest and hands. This modest-sized blood vessel, no doubt, plays an important role in the life support of the human body.

What vessels make up the superior vena cava system? The veins that transport the blood flow are located in close proximity to the heart, therefore, when the heart chambers are relaxed, they are attracted to it. These repetitive movements create circulatory system strong negative pressure.

Vessels that form the system of the superior vena cava:

1. vessels involved in nourishing the neck and chest;
2. several veins stretching from the walls of the abdomen;
3. veins of the head and cervical region;
4. venous channels of the shoulder girdle and arms.

Mergers and Confluences

Intermediate topography indicates the existence of several tributaries of the superior vena cava. The main tributaries include the brachiocephalic veins (right and left), formed as a result of the confluence of the subclavian and internal jugular veins. They do not have valves, since the constant low pressure increases the risk of injury if air enters.

The route of the left brachiocephalic vein lies behind the thymus and the manubrium of the sternum, and immediately behind it is the left carotid artery and brachial trunk. The path of the right blood thread of the same name runs from the sternoclavicular joint and passes to the upper zone of the right pleura.

In the case of congenital anomalies of the heart muscle, an additional left superior vena cava is formed. It can be safely considered an ineffective inflow, which does not exert any burden on hemodynamics.

Causes of compression

As mentioned above, the opening of the superior vena cava can be compressed. This disease is called superior vena cava syndrome.

Its course is characterized by the following pathological processes:

• oncological diseases ( lung cancer, adenocarcinoma);
• the stage of spread of metastases in breast cancer;
• syphilis;
• tuberculosis;
• retrosternal goiter thyroid gland s;
• soft tissue type of sarcoma and others.

There are frequent cases when compression occurs due to dense germination malignant tumor to one of the sites on the vein wall or due to its metastasis. Thrombosis of the superior vena cava (as well as thrombophlebitis) can become a provoking factor causing an increase in pressure in the lumen of the vessel up to 250-500 mm Hg, which threatens to damage (rupture) the vein and quickly kill the patient.

How does the syndrome manifest?

Symptoms of the syndrome can occur abruptly, without any provoking factors and precursors. This can occur at a time when the superior vena cava is tightly blocked by an atherosclerotic thrombus.

In most cases, the onset of the syndrome is characterized by the following symptoms:

• cough with increasing dyspnea effect;
• attacks of headache and dizziness;
• pain syndrome with localization in the chest area;
• dysphagia and nausea;
• change in facial expressions, facial features;
• fainting states;
• noticeable swelling of the veins in the cervical region and within the chest;
• swelling and puffiness of the face;
• cyanosis of the facial area or chest.

For the most accurate diagnosis of the syndrome of the superior vena cava, it is necessary to undergo a series of procedures aimed at examining the condition of the venous channels. Such examinations include topography, radiography and Doppler ultrasound. Having resorted to their help, it is quite possible to differentiate diagnoses and prescribe the most effective surgical treatment.

In case of deterioration of general well-being, if the above symptoms are detected, you should immediately contact the medical institution for qualified advice. Only an experienced specialist will be able to establish the diagnosis most accurately and quickly, as well as suggest appropriate treatment measures.

If thrombosis of the superior vena cava is not detected in time, deplorable health conditions can occur.

It is an important component of our body. Without it, the vital activity of human organs and tissues is impossible. Blood nourishes our body with oxygen and is involved in all metabolic reactions. Vessels and veins, through which the "energy fuel" is transported, play an important role, so even a small capillary must work at full capacity.

Only the heart matters

In order to understand vascular system heart, you need to know a little about its structure. The four-chamber human heart is divided by a septum into 2 halves: left and right. Each half has an atrium and a ventricle. They are also separated by a septum, but with valves that allow the heart to pump blood. The venous apparatus of the heart is represented by four veins: two vessels (superior and inferior vena cava) flow into the right atrium, and two pulmonary vessels into the left.

The circulatory system in the heart is also represented by the aorta, and through the aorta, which departs from the left ventricle, blood enters all organs and tissues of the human body, except for the lungs. From the right ventricle through the pulmonary artery, blood moves through the supplying bronchi and alveoli of the lung. This is how blood circulates in our body.

Venous apparatus of the heart: superior vena cava

Since the heart is small in volume, the vascular apparatus is also represented by medium-sized, but thick-walled veins. AT anterior mediastinum the heart is a vein formed by the confluence of the left and right brachiocephalic veins. It is called the superior vena cava and belongs to the systemic circulation. Its diameter reaches 25 mm, and its length is from 5 to 7.5 cm.

The superior vena cava is located deep enough in the pericardial cavity. To the left of the vessel is the ascending aorta, and to the right is the mediastinal pleura. Behind it, the anterior surface of the root of the right lung protrudes. and the right lung are located in front. Such a fairly close relationship is fraught with compression and, accordingly, a deterioration in blood circulation.

The superior vena cava empties into the right atrium at the level of the second rib and collects blood from the head, neck, upper chest, and arms. There is no doubt that this small vessel has great importance in the human circulatory system.

What vessels are represented by the system of the superior vena cava?

The blood-carrying veins are located near the heart, so when the heart chambers relax, they seem to stick to it. Due to these peculiar movements, a strong negative pressure is created in the system.

Vessels included in the system of the superior vena cava:

• several veins extending from the walls of the abdomen;
• vessels that feed the neck and chest;
• veins of the shoulder girdle and arms;
• veins of the head and neck region.

Mergers and Confluences

What are the tributaries of the superior vena cava? The main tributaries can be called the brachiocephalic veins (right and left), which are formed as a result of the confluence of the internal jugular and subclavian veins and do not have valves. Due to constant low pressure there is a risk of air getting into them when injured. The left brachiocephalic vein runs behind the manubrium of the sternum and thymus, and behind it is the brachiocephalic trunk and the left carotid artery. The right blood thread of the same name starts its way from the sternoclavicular joint and is adjacent to the upper edge of the right pleura.

Also, the tributary is an unpaired vein, which is equipped with valves located at its mouth. This vein originates in the abdominal cavity, then passes along the right side of the vertebral bodies and through the diaphragm, following behind the esophagus to the point of confluence with the superior vena cava. It collects blood from the intercostal veins and chest organs. The unpaired vein lies on the right on the transverse processes of the thoracic vertebrae.

With anomalies of the heart, an additional left superior vena cava appears. In such cases, it can be considered an incapacitated inflow, which does not bear a burden on hemodynamics.

in system

The internal jugular vein is a fairly large vein that enters the system of the superior vena cava. It is she who collects blood from the veins of the head and part of the neck. It begins near the jugular foramen of the skull and, going down, forms the c and neurovascular bundle.

The tributaries of the jugular vein are divided into intracranial and extracranial. Intracranial include:

• meningeal veins;
• diploic veins (feeding the bones of the skull);
• vessels that carry blood to the eyes;
• labyrinth veins (inner ear);
• brain veins.

Diploic veins include: temporal (posterior and anterior), frontal, occipital. All of these veins carry blood to the sinuses of the dura mater and do not have valves.

Extracranial tributaries are:

• facial vein, carrying blood from the labial folds, cheeks, earlobes;
• mandibular vein.

The pharyngeal veins, superior thyroid veins, and lingual vein drain into the internal jugular vein in the middle third of the neck on the right.

Veins of the upper limbs included in the system

On the arm, the veins are divided into deep, lying in the muscles, and superficial, passing almost immediately under the skin.

Blood enters from the fingertips into the dorsal veins of the hand, followed by the venous plexus formed by superficial vessels. The cephalic and basilar veins are subcutaneous vessels of the arm. The main vein originates from the palmar arch and venous plexus of the hand on the back. It runs along the forearm and forms the median vein of the elbow, which is used for intravenous injections.

The veins of the palmar arches are divided into two deep ulnar and radial vessels, which merge near elbow joint and two brachial veins are obtained. Then the brachial vessels pass into the axillary. continues axillary and has no branches. It is connected to the fascia and periosteum of the first rib, due to which its lumen increases when the arm is raised. The blood supply of this vein is equipped with two valves.

Vessels of the chest

The intercostal veins lie in the intercostal spaces and collect blood from the chest cavity and partially anterior abdominal wall. The tributaries of these vessels are the spinal and intervertebral veins. They are formed from vertebral plexuses located inside spinal canal.

The vertebral plexuses are vessels that repeatedly anastomose with each other, extending from the occipital foramen to the upper part of the sacrum. In the upper part of the spinal column, small plexuses develop into larger ones and flow into the veins of the spine and occiput.

Causes of compression of the superior vena cava

The causes of such an ailment as superior vena cava syndrome are such pathological processes as:

• oncological diseases (adenocarcinoma, lung cancer);
• metastases in breast cancer;
• tuberculosis;
• retrosternal goiter of the thyroid gland;
• syphilis;
• soft tissue sarcoma and others.

Often, compression occurs due to the germination of a malignant tumor in the wall of the vein or its metastasis. Thrombosis can also cause an increase in pressure in the lumen of the vessel up to 250-500 mm Hg, which is fraught with rupture of the vein and death of a person.

How does the syndrome manifest itself?

Symptoms of the syndrome can develop instantly without precursors. This occurs when the superior vena cava becomes blocked by an atherosclerotic thrombus. In most cases, symptoms develop gradually. The patient has:

• headache and dizziness;
• cough with increasing shortness of breath;
• pain in the chest;
• nausea and dysphagia;
• change in facial features;
• fainting;
• swelling of the veins in the chest and neck;
• swelling and puffiness of the face;
• cyanosis of the face or chest.

To diagnose the syndrome, several studies are necessary. Radiography and Doppler ultrasound have proven themselves well. With their help, it is possible to differentiate diagnoses and prescribe appropriate surgical treatment.

The system of the superior vena cava is formed by vessels that collect blood from the head, neck, upper limb, walls and organs of the chest and abdominal cavity. The superior vena cava itself (v. cava superior) (Fig. 210, 211, 215, 233, 234) is located in the anterior mediastinum, behind the cartilage of the 1st rib, near the sternum, and absorbs a number of large vessels.

The external jugular vein (v. jugularis externa) (Fig. 233, 234, 235) collects blood from the organs of the head and neck. It is located under the auricle at the level of the corner mandible and is formed by the confluence of the posterior auricular vein and the mandibular vein. Along the course of the external jugular vein, the following vessels flow into it:

1) posterior ear vein (v. auricularis posterior) (Fig. 234) receives blood from the posterior region;

2) occipital vein (v. occipitalis) (Fig. 234) collects blood from the occipital region of the head;

3) suprascapular vein (v. suprascapularis) (Fig. 233, 234) takes blood coming from the skin of the suprascapular region of the neck;

4) the anterior jugular vein (v. jugularis anterior) (Fig. 233, 234) is responsible for collecting blood from the skin of the chin and anterior regions of the neck, anastomoses with the vein of the same name on the opposite side, forming the jugular venous arch (arcus venosus juguli) (Fig. 233) ), and in the region of the clavicle flows into the subclavian, or internal jugular, vein.

The internal jugular vein (v. jugularis interna) (Fig. 233, 234, 235) begins near the jugular opening of the skull, goes down and, together with the common carotid artery and vagus nerve forms the neurovascular bundle of the neck. The branches flowing into it are divided into intracranial and extracranial.

The intracranial veins are:

1) veins of the brain (vv. cerebri) (Fig. 234), collecting blood from the cerebral hemispheres;

2) meningeal veins (vv. meningeae), serving the membranes of the brain;

3) diploic veins (vv. diploicae) (Fig. 234), which collects blood from the bones of the skull;

4) eye veins (vv. ophthalmicae) (Fig. 234), receiving blood from eyeball, lacrimal gland, eyelids, eye sockets, nasal cavity, external nose and forehead areas.

The blood collected by these veins enters the sinuses of the dura mater (sinus durae matris), which are venous vessels that differ from veins in the structure of the walls formed by sheets of the dura mater that do not contain muscle elements and do not collapse. The main sinuses of the brain are:

1) superior sagittal sinus (sinus sagittalis superior) (Fig. 234), passing along the upper edge of the large falciform process of the dura mater and flowing into the right transverse sinus;

2) the lower sagittal sinus (sinus sagittalis inferior) (Fig. 234), heading along the lower edge of the large falciform process and flowing into the straight sinus;

3) direct sinus (sinus rectus) (Fig. 234), which runs along the junction of the crescent of the brain with the tent of the cerebellum and merges into the transverse sinus;

4) cavernous sinus (sinus cavernosus), which is a steam room and located around the Turkish saddle. It combines with the superior petrosal sinus (sinus petrosus superior) (Fig. 234), the posterior edge of which merges with the sigmoid sinus (sinus sigmoideus) (Fig. 234), which lies in the groove of the sigmoid sinus of the temporal bone;

5) transverse sinus (sinus transversus) (Fig. 234), which is a pair (right and left) and runs along the posterior edge of the cerebellum tenon. It, lying in the transverse groove of the occipital bones, merges into the sigmoid sinus, which passes into the internal jugular sinus.

Extracranial branches of the internal jugular vein include:

1) facial vein (v. facialis) (Fig. 234), collecting blood from the skin of the forehead, cheeks, nose, lips, pharyngeal mucosa, nasal cavity and mouth, facial and masticatory muscles, soft palate and palatine tonsils;

2) mandibular vein (v. retromandibularis) (Fig. 234), into which veins flow from the scalp, the area auricle, parotid gland, lateral surface of the face, nasal cavity, chewing muscles and teeth of the lower jaw.

When moving to the neck, the following is poured into the jugular vein:

1) pharyngeal veins (vv. pharyngeales), receiving blood from the walls of the pharynx;

2) lingual vein (v. lingualis) (Fig. 234), which receives blood from the tongue, muscles of the oral cavity, sublingual and submandibular glands;

3) superior thyroid veins (vv. thyroideae superiores), collecting blood from the thyroid gland, larynx and sternocleidomastoid muscle.

Behind the sternoclavicular joint, the internal jugular vein merges with the subclavian vein (v. subclavia) (Fig. 233, 235), which takes blood from all parts of the upper limb, forming a paired brachiocephalic vein (v. brachiocephalica) (Fig. 233, 234, 235), collecting blood from the head, neck and upper limbs. The veins of the upper limb are divided into superficial and deep.

Superficial veins are located in the subcutaneous tissue on the own fascia of the muscles of the upper limb, heading independently of the deep veins, and receive blood from the skin and subcutaneous tissue. Their roots are networks of vessels on the palmar and dorsal surfaces of the hand. From the most developed venous network of the rear of the hand (rete venosum dorsale manus) originates the head, or lateral saphenous, vein of the arm (v. cephalica) (Fig. 233, 235). It rises along the radial (lateral) edge of the forearm, passes to its front surface and, reaching the elbow, anastomoses with the royal, or medial saphenous, vein of the arm using the intermediate vein of the elbow (v. intermedia cubiti). Then the head vein of the arm goes along the lateral part of the shoulder and, having reached the subclavian region, flows into the axillary vein.

Royal vein (v. basilica) (Fig. 233, 235) is a large skin vessel, starting, like the head vein, from the venous network of the back of the hand. It is directed along the posterior surface of the forearm, smoothly passing to its anterior surface, and in the area of ​​the elbow bend it connects with the intermediate vein of the elbow and rises along the medial part of the shoulder. At the level of the border between the lower and middle thirds of the shoulder, the royal vein flows into the shoulder.

Rice. 234. Diagram of the veins of the head and neck 1 - diploic veins; 2 - superior sagittal sinus; 3 - veins of the brain; 4 - lower sagittal sinus; 5 - direct sinus; 6 - cavernous sinus; 7 - ophthalmic vein; 8 - upper petrosal sinus; 9 - transverse sinus; 10 - sigmoid sinus; 11 - rear ear vein; 12 - occipital vein; 13 - pharyngeal vein; 14 - mandibular vein; 15 - lingual vein; 16 - facial vein; 17 - internal jugular vein; 18 - anterior jugular vein; 19 - superior thyroid vein; 20 - external jugular vein; 21 - suprascapular vein; 22 - brachiocephalic veins; 23 - superior vena cava

Rice. 235. Scheme of the veins of the upper limb 1 - external jugular vein; 2 - suprascapular vein; 3 - internal jugular vein; 4 - subclavian vein; 5 - brachiocephalic vein; 6 - axillary vein; 7 - posterior intercostal veins; 8 - brachial veins; 9 - head vein of the hand; 10 - royal vein; 11 - radial veins; 12 - ulnar veins; 13 - deep venous palmar arch; 14 - superficial venous palmar arch; 15 - palmar digital veins

The deep veins of the upper limb accompany the arteries, two for each. Their roots are the venous networks of the palmar surface, formed by the palmar digital veins (vv. digitales palmares) (Fig. 235), which flow into the superficial and deep venous palmar arches (arcus venosi palmares superficiales et profundus) (Fig. 235). The veins extending from the palmar arches pass to the forearm and form two cubital veins (vv. ulnares) (Fig. 235) and two radial veins (vv. radiales) (Fig. 235), anastomosing with each other. The ulnar and radial veins absorb the veins coming from the muscles and bones, and unite in the region of the radial fossa into two brachial veins (vv. brachiales) (Fig. 233, 235). The veins that collect blood from the skin and muscles of the shoulder flow into the brachial veins, and in the axillary fossa, both brachial veins form the axillary vein (v. axillaris) (Fig. 233, 235). The veins that receive blood from the muscles of the shoulder girdle, the muscles of the shoulder and partially from the muscles of the back and chest muscles flow into the axillary vein. At the level of the outer edge of the first rib, the axillary vein flows into the subclavian, collecting transverse vein of the neck (v. transversa cervicis), and the suprascapular vein (v. suprascapularis) (Fig. 235), which accompany the arteries of the same name.

The veins of the upper limb have valves. At subclavian vein there are two of them. The place of its confluence with the internal jugular vein on each side is called the venous angle (left and right). At the confluence, the brachiocephalic veins are formed, which receive veins directed from the muscles of the neck, thymus and thyroid glands, trachea, mediastinum, pericardium, esophagus, chest wall, spinal cord, as well as the left and right highest intercostal veins (vv. intercostales supremae sinistra et dextra), collecting blood from the intercostal spaces and accompanying the arteries of the same name.

Behind the cartilage of the right I rib and sternum, the brachiocephalic veins join and form the main trunk of the superior vena cava. The superior vena cava itself has no valves. At the level of the II rib, it passes into the cavity of the heart bag and flows into the right atrium. Along the way, veins flow into it, collecting blood from the pericardial sac and mediastinum, as well as an unpaired vein (v. azygos), which is a continuation of the right ascending lumbar vein (v. lumbalis ascendentis dextra) (Fig. 233) and receives blood coming from the walls of the thoracic and abdominal cavities. The veins coming from the bronchi and esophagus, the posterior intercostal veins (vv. intercostales anteriores) (Fig. 233, 235), collecting blood from the intercostal spaces, and the semi-unpaired vein (v. hemiazygos) flow into the unpaired vein. The veins of the esophagus, mediastinum and part of the posterior intercostal veins also flow into the semi-unpaired vein.

21. Superior vena cava and brachiocephalic veins, their formation, topography, tributaries.

Superior vena cava (s.cdvasuperior) - this is a short valveless vessel with a diameter of 21-25 mm and a length of 5-8 cm, which is formed as a result of the confluence of the right and left brachiocephalic veins behind the junction of the cartilage of the first right rib with the sternum (Fig. 109). This vein follows vertically down and at the level of the connection of the third right cartilage with the sternum flows into the right atrium. In front of the vein are the thymus and the mediastinal part of the right lung covered with pleura. The mediastinal (mediastinal) pleura is adjacent to the vein to the right, and the ascending aorta is to the left. With its posterior wall, the superior vena cava is in contact with the anterior surface of the root of the right lung. The unpaired vein flows into the superior vena cava on the right, and the small mediastinal and pericardial veins on the left. The superior vena cava collects blood from three groups of veins: veins of the walls of the chest and partially abdominal cavities, veins of the head and neck, and veins of both upper limbs, i.e. from those areas that are supplied with blood by the branches of the arch and the thoracic part of the aorta (Table 16).

Unpaired vein (s.azygos) is a continuation in the thoracic cavity right ascending lumbar vein(v. lumb & lis ascendens dextra), which passes between the muscle bundles of the right leg of the lumbar part of the diaphragm into the posterior mediastinum and on its way anastomoses with the right lumbar veins that flow into the inferior vena cava. Behind and to the left of the unpaired vein are the vertebral column, the thoracic aorta and thoracic duct, as well as the right posterior intercostal arteries. The esophagus lies in front of the vein. At the level of the IV-V thoracic vertebrae, the unpaired vein goes around the root of the right lung behind and above, then goes forward and down and flows into the superior vena cava. There are two valves at the mouth of the unpaired vein. The semi-unpaired vein and the veins of the posterior wall of the chest cavity flow into the unpaired vein on its way to the superior vena cava: right top nya intercostal vein; posterior intercostal veins, as well as veins of the organs of the chest cavity: esophageal, bronchial, pericardial and mediastinal veins.

Semi-jeparous vein ( v . hemiazygos ), which is sometimes called the left, or small unpaired, vein, thinner than the unpaired vein, since only 4-5 lower left posterior intercostal veins flow into it. The semi-unpaired vein is a continuation of the left ascending lumbar vein(v. lumbdis ascendens sinistra), passes between the muscle bundles of the left leg of the diaphragm into the posterior mediastinum, adjacent to the left surface of the thoracic vertebrae. To the right of the semi-unpaired vein are the thoracic aorta, behind the left posterior intercostal arteries. At the level of the VII-X thoracic vertebrae, the semi-unpaired vein turns sharply to the right, crosses the spinal column in front, is located behind the aorta, esophagus and thoracic duct) and flows into the unpaired vein. The accessory semi-unpaired vein flows into the semi-unpaired vein from top to bottom.(v. hemiazygos accessoria), receiving 6-7 superior intercostal veins(I- VII), as well as the esophageal and mediastinal veins. The most significant tributaries of the unpaired and semi-unpaired veins are the posterior intercostal veins, each of which is connected at its anterior end to the anterior intercostal vein, a tributary of the internal thoracic vein. The presence of such connections of the veins creates the possibility of outflow of venous blood from the walls of the chest cavity back into the unpaired and semi-unpaired veins and forward into the internal thoracic veins.

Posterior intercostal veins (w. intercostdles posteriores) are located in the intercostal spaces next to the arteries of the same name (in the groove of the corresponding rib). These veins collect blood from the tissues of the walls of the chest cavity and partly from the anterior abdominal wall (lower posterior intercostal veins). The dorsal vein empties into each of the posterior intercostal veins.(v. dorsalis), which is formed in the skin and muscles of the back, and the intervertebral vein(v. intervertebralis), formed from the veins of the external and internal vertebral plexuses. A spinal branch flows into each intervertebral vein (r.spinalis), which, along with other veins (vertebral, lumbar and sacral) is involved in the outflow of venous blood from the spinal cord.

Internal (anterior and posterior) vertebral venous plexuses (plexus venosi vertebrals interni, anterior et post6 rior) are located inside the spinal canal (between the hard shell of the spinal cord and the periosteum) and are represented by repeatedly anastomosing veins (Fig. 110). The plexuses extend from the foramen magnum to the top of the sacrum. The spinal veins and veins of the spongy substance of the vertebrae flow into the internal vertebral plexuses. From these plexuses, blood flows through the intervertebral veins passing through the intervertebral foramina (next to the spinal nerves), flows into the unpaired, semi-unpaired and additional semi-unpaired veins. Blood from the internal plexuses also flows intoexternal (anterior and posterior) venous vertebral plexuses (plexus venosi vertebrals externi, anterior et posterior), which are located on the anterior surface of the vertebrae, and also braid their arcs and processes. From the external vertebral plexuses, blood flows into the posterior intercostal, lumbar and sacral veins.(vv. intercostdles posteriores, lumbales et sacrales), as well as directly into the unpaired, semi-unpaired and additional semi-unpaired veins. At the level of the upper part of the spinal column, the veins of the plexuses flow into the vertebral and occipital veins.(vv. vertebrals et occipitdles).

Brachiocephalic veins (right and left) (vv. brachiocephdlicae, dextra et sinistra) valveless, are the roots of the superior vena cava. They collect blood from the organs of the head and neck and upper extremities. Each brachiocephalic vein is formed from two veins - the subclavian and internal jugular (Fig. 111).

Left brachiocephalic vein formed behind the left sternoclavicular joint. The vein has a length of 5-6 cm, follows from the place of its formation obliquely down and to the right behind the handle of the sternum and thymus. Behind this vein are the brachiocephalic trunk, the left common carotid and subclavian arteries. At the level of the cartilage of the right 1st rib, the left brachiocephalic vein connects with the right vein of the same name, forming the superior vena cava.

Right brachiocephalic vein 3 cm long is formed behind the right sternoclavicular joint. Then the vein descends almost vertically behind the right edge of the sternum and is adjacent to the dome of the right pleura.

Small veins from the internal organs flow into each brachiocephalic vein: thymic veins (vv. thymicae); pericardial veins (vv, pericardidcae); pericardial phrenic veins (w. pericardial ophreiiicae); bronchial veins (vv. bronchidles); esophageal veins (vv. oesophagedles); mediastinal veins (vv. medi-astinales) - from lymph nodes and connective tissue of the mediastinum. Larger tributaries of the brachiocephalic veins are the inferior thyroid veins (vv. thyroidede inferiores, only 1-3), through which blood flows from unpaired thyroid plexus(plexus thyroideus impar), and the inferior laryngeal vein (v. laryngea inferior), which brings blood from the larynx and anastomoses with the superior and middle thyroid veins.

Vertebral vein(v. vertebrdlis) passes along with the vertebral artery through the transverse openings of the cervical vertebrae to the brachiocephalic vein, taking on its way the veins of the internal vertebral plexuses.

deep jugular vein(v. cervicalis profunda) starts from the external vertebral plexus, collects blood from the muscles and fascia located in the occipital region. This vein passes behind the transverse processes of the cervical vertebrae and flows into the brachiocephalic vein near the mouth of the vertebral vein or directly into the vertebral vein.

Internal thoracic vein(v. thoracica interna) steam room, accompanies the internal thoracic artery. The roots of the internal thoracic veins are the superior epigastric vein (v. epigastrica superioris) and the musculophrenic vein (v. musculophrenica). The superior epigastric vein anastomoses in the thickness of the anterior abdominal wall with the inferior epigastric vein, which flows into the external iliac vein. The anterior intercostal veins (w. intercostales anteriores) lying in the anterior intercostal spaces flow into the internal thoracic vein, which anastomose with the posterior intercostal veins that flow into the unpaired or semi-unpaired vein.

The highest intercostal vein (v. intercostalis suprema) flows into each brachiocephalic vein, right and left, collecting blood from 3-4 upper intercostal spaces.