Bypass of superior vena cava: Six years' experience with spiral vein graft for obstruction of superior vena cava due to benign and malignant disease
Doty, D.B.
Journal of Thoracic and Cardiovascular Surgery 83(3): 326-338
1982
ISSN/ISBN: 0022-5223 PMID: 7038314 Document Number: 186172
Ten patients had operations for obstruction of the superior vena cava (SVC) with SVC syndrome. Four patients had fibrosing mediastinitis and six and had bronchogenic carcinoma. A composite spiral vein graft was placed between the left jugular--subclavian vein and the right atrium to bypass the completely occluded SVC. The graft was constructed from the patient's own saphenous vein, which was split longitudinally and wrapped around a stent in spiral fashion. The edges of the vein were sutured together to form a large autogenous conduit. All patients were immediately relieved of SVC obstructive symptoms and signs. All grafts were patient at 7 days to 18 months, as determined by conventional or radionuclide venography or contrast-enhanced computerized axial tomography. The fact that SVC syndrome has not returned in any patient implies long-term patency. All patients with benign disease continue asymptomatic 3 months to 6 years after operation and have returned to gainful employment. All patients with SVC obstruction resulting from cancer died 1 to 21 months (mean 10.7 months) postoperatively. Spiral vein bypass graft provides effective treatment for SVC obstruction with immediate and long-term relief of SVC syndrome.