Hemodialysis-associated superior vena cava syndrome: A management framework from lesion characteristics to individualized clinical decision-making

Abstract

Background:

Superior vena cava syndrome (SVCS) is a severe and challenging complication in hemodialysis patients, leading to impaired dialysis function and reduced quality of life. Current management approaches for this population lack specificity.

Objective:

This review aims to develop personalized clinical management recommendations for SVCS centered on hemodialysis patients, based on collateral circulation and clinical symptom assessment, building upon traditional technical descriptions. This will assist vascular access physicians in making scientifically sound and safe decisions.

Methods:

This review is based on a comprehensive analysis and integration of evidence from literature retrieved from PubMed, Web of Science, Embase, and the Cochrane Library up to August 2025. Search keywords included “superior vena cava syndrome,” “hemodialysis,” “vascular access,” “collateral circulation,” and “angioplasty/stenting.” The article categories screened encompassed case reports, retrospective studies, cohort studies, systematic reviews, and others. After an initial screening of 306 documents, 79 articles with the highest relevance were ultimately included for synthesis and summary.

Results:

The analysis revealed a unique higher-risk profile for SVCS in dialysis patients. A key finding of our study highlights the critical role of collateral circulation, which jointly determines the severity of clinical symptoms with the degree of SVC stenosis. Building upon previously proposed anatomical classifications of SVC lesion locations, we present a novel management framework. This framework guides personalized decision-making by evaluating bypass adequacy, clinical symptom severity, and risk stratification. It aims to assist clinicians in making individualized trade-offs between active interventions (e.g. angioplasty/stenting), conservative management, and strategic abandonment of vascular access.

Conclusion:

This review proposes a novel, patient-centered framework for managing hemodialysis vascular access complications. The shift from purely technical approaches to a strategic decision-making process requires comprehensive consideration of SVC stenosis severity, collateral assessment, lesion characteristics, and patient-specific factors to balance symptom relief, vascular access preservation, and safety.