Superior vena cava (SVC) syndrome is a debilitating condition related to a variety of benign and malignant processes causing intrisinc or extrinsic compression of the SVC. Patients typically present with facial swelling, shortness of breath, and headache related to venous hypertension in the upper body. Endovascular therapy is effective and considered first line therapy. Open reconstruction is needed in conjuction with oncological resection or when endovascular therapy fails. This chapter summarizes the evaluation and treatment of patients with SVC syndrome.