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Spiral vein graft for obstruction of the superior vena cava: a case report
Insights
Catheter-induced superior vena caval thrombosis, a rare pacemaker complication, can be treated with saphenous vein bypass grafting if anticoagulation fails. This surgical approach led to remarkable patient improvement.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Medical Device Complications
Background:
- Transvenous pacemaker placement can lead to rare but serious complications.
- Superior vena caval thrombosis (SVCT) is an infrequent outcome associated with these devices.
Observation:
- A case of catheter-induced SVCT in a 44-year-old male patient is presented.
- The obstruction was successfully bypassed using a composite spiral graft of saphenous vein.
Findings:
- The bypass graft was anastomosed to the innominate vein and the right atrial appendage.
- The patient experienced immediate and remarkable improvement post-operation with an uncomplicated course.
Implications:
- Surgical bypass grafting is a viable treatment for refractory SVCT post-pacemaker placement.
- A recommended treatment strategy involves initial anticoagulation followed by bypass grafting if conservative measures fail.
Abstract:
Catheter-induced superior vena caval thrombosis is a rare complication of the placement of transvenous pacemakers. The authors report such a case in a 44-year-old man. A composite spiral graft of saphenous vein was used to bypass the obstruction. It was anastomosed end to side to the innominate vein and then to the right atrial appendage. The patient improved remarkably immediately after the operation and had an uncomplicated postoperative course. The authors discuss the surgical technique involved and recommend for this rare condition an initial trial of anticoagulant therapy followed by bypass grafting, using the technique they describe, if anticoagulation fails.