Bleeding Downhill Esophageal Varices Associated With Benign Superior Vena Cava Syndrome: A Case Report

Downhill esophageal varices are an uncommon source of upper gastrointestinal bleeding and may be easily overlooked when no underlying liver disease is present. In this report, a young patient receiving long-term hemodialysis developed recurrent bleeding episodes caused by severe central venous obstruction secondary to a chronically implanted catheter. Proximal esophageal varices were only identified during a later endoscopic evaluation, which prompted targeted imaging and revealed complete occlusion of the central thoracic veins. The patient subsequently underwent endovascular reconstruction of the obstructed venous pathways, including angioplasty, stenting, and catheter exchange. This intervention resulted in stable venous patency and complete cessation of bleeding during follow-up. This case highlights the importance of considering superior vena cava-related varices as a potential cause of unexplained upper gastrointestinal bleeding and demonstrates that restoring venous outflow can provide durable clinical resolution.