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Superior vena cava obstruction: bypass using spiral vein graft
J R Doty1, J H Flores, D B Doty
1Department of Surgery, LDS Hospital, Salt Lake City, Utah, USA.
The Annals of Thoracic Surgery
|May 13, 1999
Summary
Composite spiral vein grafts offer excellent long-term patency for superior vena cava (SVC) obstruction, relieving SVC syndrome. This study confirms favorable outcomes in patients followed for over 23 years.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Superior vena cava (SVC) obstruction can cause severe SVC syndrome.
- Composite spiral saphenous vein grafts have shown promising midterm results for SVC bypass.
Purpose of the Study:
- To evaluate the long-term efficacy and patency of composite spiral saphenous vein grafts in patients with superior vena cava obstruction.
Main Methods:
- Sixteen patients (aged 17-68) with benign SVC obstruction underwent bypass surgery using autologous spiral saphenous vein grafts.
- Graft diameters ranged from 9.5 to 15.0 mm, with inflow from the innominate or internal jugular veins.
- Follow-up extended up to 23 years and 8 months (mean 10.9 years).
Main Results:
- Fourteen out of 16 grafts remained patent for up to 23 years.
- All but one patient were relieved of SVC syndrome.
- Two grafts failed within the first year due to thrombosis or aggressive fibrosing mediastinitis.
Conclusions:
- Composite spiral vein bypass grafts are an effective treatment for obstructed superior vena cava (SVC).
- This surgical technique demonstrates excellent long-term patency and sustained relief of SVC syndrome.