Subject(s)
Anastomosis, Surgical , Hypoxia/etiology , Hypoxia/therapy , Arteriovenous Shunt, Surgical/methods , Brachiocephalic Veins/anatomy & histology , Brachiocephalic Veins/surgery , Cardiopulmonary Bypass , Coronary Angiography , Female , Fontan Procedure/methods , Humans , Infant , Postoperative Complications/therapy , Pulmonary Artery/pathology , Pulmonary Artery/surgery , Thymectomy , Vena Cava, Inferior/surgery , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Superior/abnormalitiesABSTRACT
Objective : To evaluate the safety, feasibility, and outcome following radical excision of thymoma with resection and reconstruction of invaded mediastinal vessels. Study Design : A retrospective study. Patients and Methods : Six patients with thymoma invading the superior vena cava (SVC) and/or the brachiocephalic veins (BCVs) were reviewed in this study. All the patients underwent radical excision of the tumor along with invaded mediastinal vessels followed by vessel reconstruction or repair. The clinical presentation, operative details, postoperative course, and follow-up were reviewed and analyzed. Results : Three patients presented with features suggestive of SVC syndrome. Contrast-enhanced computed tomography of the chest was the primary imaging modality, which detected a tumor with invasion of major mediastinal veins. WHO type B2 was the commonest histologic type, which was seen in 4 cases. Intraoperatively, SVC invasion, SVC and BCV invasion, and BCV invasions alone were seen in 1, 2, and 3 cases, respectively. The vessels were reconstructed with a prosthetic graft in 3 patients, and autologous pericardial tube graft was used in 1 patient. Two patients had primary repair of the wall of the involved vessel. Postoperative course was complicated by ventilator support requirement in 2, graft thrombosis in 2, acute renal failure in 1 and pneumonia in 1 patient. All patients are alive at the end of follow-up period ranging between 18 and 24 months. Conclusion: Thymoma excision with the reconstruction of SVC or BCV is safe and feasible in experienced hands.
Subject(s)
Adult , Brachiocephalic Veins/surgery , Humans , Male , Mediastinum/surgery , Middle Aged , Neoplasm Staging , Neovascularization, Pathologic/surgery , Plastic Surgery Procedures/methods , Retrospective Studies , Thymoma/blood supply , Thymoma/pathology , Thymoma/surgery , Vascular Surgical Procedures/methods , Vena Cava, Superior/surgeryABSTRACT
Desde marzo de 1975 a julio de 1991 hemos realizado 900 accesos vasculares en pacientes con insuficiencia renal terminal. En 53 ocasiones (5,8%) se empleó la fístula de antebrazo proximal como procedimiento primario o secundario en los pacientes sin vena cefálica disponible a nivel del antebrazo. Esta técnica, no descrita previamente en la literatura, consiste en el empleo de una vena comunicante del antebrazo proximal para dar flujo al sistema venoso superficial del brazo mediante anastomosis terminolateral con la arteria radial proximal. Se describe la técnica y se evalúan los resultados. La edad promedio fue de 50 años, 28 hombres (55%) y 23 mujeres (45%). En 36 pacientes (70,5%) se había efectuado uno o más procedimientos previos. Hubo 12 complicaciones (22,6%): 9 trombosis (17%), 1 déficit de flujo (1,9%), 1 hemorragia (1,9%) y 1 dilatación aneurismática (1,9%). No hubo infecciones. La permeabilidad actuarial a 12, 24 y 36 meses fue de 96, 91 y 76% respectivamente. Aunque los resultados con esta técnica son algo inferiores a los de la fístula tradicional, son superiores a aquellos obtenidos con el empleo de PTFE. La fístula de antebrazo proximal es una buena alternativa que permite evitar la molesta fístula del pliegue del codo y muchas veces evita el empleo de PTFE