Bypass of the superior vena autologous spiral saphenous cava vein using graft

ABSTRACT

Bypassing an obstructed superior vena cava represents a challenge to the surgeon due to absence of a suitable graft with a good long term patency. This study was conducted to assess the technique used to fashion the spiral saphenous vein graft, clinical improvement of the patients and postoperative patency of the fashioned graft with mid term follow up. This study was prospectively carried out in the sections of cardiotboracic surgery and chest internal medicine of Kasr El Aini Faculty of Medicine as well as private practice between 1999 and 2006. Eight patients suffering from SVC obstruction due to a nonmalignant cause were submitted to this study. A benign aetiology was proved in all 8 cases [100%]. Thoracic CT scanning showed idiopathic fibro sing mediastinitis in a five patients [62.5%] and dense mediastinal scarring with enlargement of different mediastinal lymph node groups for chronic non-specific mediastinal granuloma in a single patient [12.5%] whereas 2 patients had Behcet Syndrome [25%]. Preoperative tissue diagnosis confirming benignity and excluding malignancy by lymph node sampling of one or two different groups in the thorax the left supraclavicular group in 4 cases [50%]; axillary group 1 case [12.5%]; or the in ternal mammary group in 3 cases [37.5%]. Preoperatively, these patients were following different regimens of medical treatment that included diuretics. bronchodilatois, as well us corticosteroids. The Saphenous Vein Graft [SVG], harvested from the medial aspect of the thigh, was fashioned spirally and sutured using 7/0 prolene to form a tube graft that was anastomosed proximally to the patent left innominate vein and distally to the right atrial appendage. None of our patients died. All 8 patients had prompt relief of their symptoms [upper limbs, head and neck congestion, and the severe dyspnea and orthopnoea] immediately after surgery together with disappearance of dilated superficial veins, and the negative need for medical treatment, In a mean post operative follow- up period of 3 years and 3 months, 7 patients [87.5%] remained symptom-free with a patent graft visualized by venography. Only one patient [12.5%], who had hypercoagulability due to Behcet syndrome, needed revision of the graft after he stopped Warfarin anticoagulation. In our experience, fashioning the SVG in a spiral manner represented an appealing option as a bypass conduit. Using it to bypass the obstructed SVC in non-malignant cases of SVC occlusion, showed sound safety, alleviated symptomatology, and provided a good postoperative patency rate