Superior Vena Cava Bypass with Superficial Femoral Vein for Benign Superior Vena Cava Syndrome

Superior vena cava (SVC) syndrome can result from benign causes such as temporary hemodialysis catheters placed into the central veins. The indications for open, surgical revascularization are rare and usually reserved for patients whose symptoms are refractory to anticoagulation and endovascular treatment. The current report documents the case of a 54-year-old woman with recurrent SVC syndrome secondary to long-term indwelling central venous catheters for total parenteral nutrition. She presented to the vascular service with moderate head/neck edema and persistent headaches despite chronic anticoagulation and multiple previous endovascular attempts including both angioplasty and stenting. An internal jugular-SVC bypass was performed using autogenous superficial femoral vein (SFV), which resulted in the resolution of her symptoms and a patent graft 12 months postoperatively. Autogenous SFV is an ideal conduit for central vein revascularization secondary to its size, relative ease associated with harvesting, and handling characteristics. It may be the ideal conduit for revascularization in patients with SVC syndrome secondary to benign causes because of their favorable life expectancy, although documentation of long-term graft patency is necessary.     

Bypass of Superior Vena Cava with Spiral Vein Graft

The superior vena cava was successfully bypassed in a patient with superior vena cava syndrome due to granulomatous mediastinitis. A spiral vein graft constructed from autogenous vein was utilized. Complete relief of symptoms and graft patency documented by venography six months after the operation confirm the usefulness of this procedure in patients with superior vena cava obstruction.     

上腔静脉综合征的外科治疗

目的报告５例上腔静脉综合征外科治疗经验及体会。方法２例行颈内静脉－大隐静脉转流术，３例行颈外静脉－大隐静脉转流术。结果无术后并发症及手术死亡。术后近期疗效满意５例，远期疗效满意２例。结论外科手术治疗上腔静脉综合征能明显改善患者的预后；但由于上腔静脉综合征病因、梗阻部位和范围不同，手术方法应有所选择。     

Mediastinal Fibrosis and Superior Vena Cava Syndrome

Superior vena cava syndrome is a clear sign for clinicians of infiltrative mediastinal involvement, usually caused by neoplasms in this location, and it is an indicator of poor prognosis. However, other diseases of benign origin can also cause these alterations. We present the case of a 34-year-old patient who debuted with symptoms of superior vena cava syndrome due to idiopathic mediastinal fibrosis, which presented a torpid evolution and few therapeutic alternatives.     

恶性肿瘤所致上腔静脉压迫综合征的介入治疗

目的 探讨采用介入方法治疗恶性肿瘤所致上腔静脉阻塞综合征的疗效及临床意义.方法 13例恶性肿瘤所致上腔静脉阻塞综合征患者中,肺癌伴纵隔淋巴结转移8例,食管癌纵隔淋巴结转移2例,纵隔恶性肿瘤2例,乳腺癌纵隔淋巴结转移1例,均经原发灶病理证实为恶性.经右侧股静脉入路,以猪尾巴导管于狭窄段近端或远端造影,明确狭窄部位、长度、程度,无局部血栓形成者直接置入Wallstent支架(Boston Scientific,USA),1例同时置入Z形支架(COOK,USA),合并血栓病例留置溶栓导管局部溶栓后再置入支架.结果 13例全部开通成功,手术成功率100%,狭窄段平均长度4.3 cm(3～6 cm).1例置入2枚支架,其余患者均置入1枚支架.6例在支架置入前行溶栓治疗.开通前后梗阻远侧卧位测静脉压,术前(26.2±1.6) cm H2O,术后降至(4.3±0.8) cm H2O,置入支架后造影示侧支静脉完全消失,上腔静脉阻塞症状于术后即刻至术后3 d完全消退.8例术后4～10个月内死于肿瘤多处转移造成脏器功能衰竭,其余5例(包括后续治疗的3例)存活,随访8～26个月,中位数13个月,所有病例上腔静脉阻塞症状未再复发.结论 上腔静脉支架置入部分联合导管局部溶栓治疗是恶性肿瘤所致上腔静脉阻塞综合征有效的微创治疗方法.     

Hyperhomocysteinemia as a Cause of Superior Vena Cava Syndrome

A case is presented in which superior vena cava (SVC) syndrome was caused by a stenosis of the SVC due to thrombosis. Hyperhomocysteinemia was diagnosed as a possible underlying mechanism. The role of hyperhomocysteinemia as a risk factor for the development of recurrent venous thrombosis, its diagnosis, and treatment are discussed.     

Superior Vena Cava Syndrome post Minimally Invasive Mitral Valve Repair

Abstract We describe an unusual presentation of cardiac tamponade as superior vena cava syndrome post minimally invasive mitral valve repair. The tamponade was caused by local compression of junction between the right atrium and superior vena cava. This case illustrates the importance of using transesophageal echocardiogram in postoperative management of cardiac surgery patients. (J Card Surg 2010;25:174‐175)     

肺癌合并上腔静脉综合征的外科治疗

目的报告肺切除合并全上腔静脉切除人造血管置换术治疗肺癌伴上腔静脉综合征患者的结果。方法１９９４年９月～１９９６年１１月，行肺切除合并全上腔静脉切除，人造血管置换重建术，治疗侵及上腔静脉的Ⅲｂ期肺癌３例。其中支气管、肺动脉袖状成型右上叶切除２例，右全肺切除１例。结果本组无手术死亡和严重手术并发症；术后无癌存活超过２８月１例，９月１例，２月１例。结论肺切除合并全上腔静脉切除、人造血管置换重建术，治疗肺癌合并上腔静脉综合征，能明显延长这类患者的近期和长期生存时间。