[Reduction of Downhill Esophageal Varices After Intra-thoracic Venous Reconstruction]

The patient was a 54-year-old male. He underwent invasive seminoma resection, bypass grafting from the left subclavian vein to the right atrial appendage, and patch plasty of the superior vena cava( SVC) 18 years ago in 1990. In 1992, graft obstruction was demonstrated, and in 1994, subsequent downhill esophageal varices developed. Varices deteriorated to grade F3 with a red-colored sign in 2008. Therefore, bypass grafting from bilateral subclavian veins to the right atrial appendage was performed to prevent rupture. Endoscopy performed two weeks after surgery showed that the varices had improved to grade F1. The patient was discharged without adverse events. In 2023, the graft remained patent and the varices did not worsen. After SVC reconstruction, strict follow-up is necessary because fatal event in esophageal varices can occur owing to graft obstruction.