Urgent inferior vena cava replacement with an autologous pericardium tube graft

Angioplasty for the treatment of left brachiocephalic vein aneurysm: a case report

BACKGROUND

Brachiocephalic vein aneurysm is a rare vascular malformation, which is often reported in case reports. At present it has attracted much attention due to the serious complications, such as vein aneurysm rupture, pulmonary embolism, venous thrombosis, etc. We report a case of left brachiocephalic vein aneurysm with compression symptoms.

CASE PRESENTATION

a 52-year-old male who was admitted to our hospital with irritating cough for more than 1 month. Chest contrast-enhanced CT showed a localized expansion of 5.2 cm in diameter of the left brachiocephalic vein in the anterior mediastinum. The patient received venous angioplasty with brachiocephalic vein aneurysm resection, and the postoperative recovery was well.

CONCLUSION

Surgical operation is an effecive treatment method for brachiocephalic vein aneurysm, but it is still necessary to choose the appropriate way according to the type, size, location, lesion scope and complications of the vein aneurysm.

Autologous pericardium used for reconstruction of left innominate vein in patient with mediastinal venous aneurysm:a case report

Background

Mediastinal venous aneurysm is a very rare disease and can be easily misdiagnosed. Patients are often asymptomatic while venous aneurysm of large size with adjacent structures oppressed can lead to discomfort. The surgical treatment for aneurysm of large vessels is often complex and challenging.

Case presentation

We reported a 52-year-old man with mediastinal mass who received operation on July 2019 in our hospital. Left innominate vein aneurysm was diagnosed during operation with superior vena cava involved. The aneurysm was resected and pericardium was taken to repair part wall of superior vena cava and reconstruct left innominate vein. The patient’s postoperative course was uneventful.

Conclusions

Venous aneurysm should be considered when mediastinal mass has no clear boundary with large veins or even seems to connect with them. Magnetic resonance imaging, computed tomographic angiography and invasive venography can be performed to further evaluate the mass once diagnosis of venous aneurysm was suspected. Using pericardium to repair large veins is a good choice which is safe and costless.

Transient Budd-Chiari syndrome as an unpredictable complication of supradiaphragmatic inferior vena cava reconstruction after blunt thoracic trauma: A case report

RATIONALE

Supradiaphragmatic inferior vena cava (IVC) injury due to blunt thoracic trauma is extremely rare. Budd-Chiari syndrome (BCS) is also rare and presents with ascites, abdominal pain, hepatomegaly, leg swelling, and jaundice. Its etiology is diverse, and it is rarely caused by trauma.

PATIENT CONCERNS

A 36-year-old man with blunt trauma from a traffic accident presented with chest pain. Chest computed (CT) and emergency surgery with CPB revealed completely transected supradiaphragmatic inferior vena cava (IVC), which reconstruction was essential.

DIAGNOSES

BCS caused by impaired hepatic venous drainage through a reconstructed neo-IVC after severe blunt trauma injury to the supradiaphragmatic IVC was diagnosed.

INTERVENTION

Hepatic failure, ascites, leg swelling, and jaundice were resolved post-insertion of a veno-venous extracorporeal membrane oxygenator (V-V ECMO) for hepatic venous drainage, but these clinical symptoms reappeared after ECMO removal.

OUTCOME

The patient died from rapidly progressing sepsis, pneumonia, and acute renal failure during repeated insertion of ECMO and weaning off ECMO.

LESSONS

Reconstructing and improving the patency of the supradiaphragmatic IVC is essential for successful hepatic venous drainage. Additionally, a surgical strategy focused on graft selection can prevent kinking stenosis, and possibly BCS, especially in emergency surgeries. A ring-supported synthetic graft should be considered an alternative to improve long-term patency and survival rate.