Technical options in reconstruction of large mediastinal veins

Twelve patients who underwent graft replacement of the large mediastinal veins were reviewed. A preoperative superior vena caval (SVC) syndrome was present in seven patients. The most frequent diagnosis was a primary thoracic malignant neoplasm (10 patients). Reconstruction was performed with a pericardial tube in four patients, venae saphena magna in three patients, umbilical vein in three patients, and Dacron grafts in two patients. A temporary bypass was used in three patients. All the patients survived the operation. Eight patients died within 15 months of the surgery. Four patients are long-term survivors without signs of an SVC syndrome. Based on our experience and a review of the literature, we recommend the use of two autogenous vein grafts or a ringed polytetrafluoroethylene graft with a diameter of about one half that of the normal SVC to replace the large mediastinal veins.