Aortic arch homograft as a bypass conduit for superior vena cava obstruction

Vascular homografts as bypass grafts for superior vena cava syndrome due to idiopathic fibrosing mediastinitis

Fibrosing mediastinitis can lead to superior vena cava obstruction by generating a fibroinflammatory mass in the mediastinum. Surgical caval reconstruction with conduits could be indicated for cases of unsuccessful or technically unfeasible endovascular stenting and angioplasty. The use of cryopreserved vascular homografts seems to be better than prosthetic conduits for mid- and long-term patency, as was observed in the case we have described in the present report.

Leiomyosarcoma of the Retrohepatic Vena Cava Treated by Excision and Reconstruction With an Aortic Homograft: A Case Report and Review of Literature

Leiomyosarcoma of the retrohepatic inferior vena cava is a rare entity and presents a number of diagnostic and therapeutic challenges. Here such a case is presented in which the retrohepatic inferior vena cava was excised after full mobilization of the liver under venovenous bypass. The continuity of the vena cava was restored with cryopreserved aortic homograft. The technical details with regard to total vena caval clamping, venovenous bypass, hepatic inflow occlusion, techniques of reconstruction, including the use of cryopreserved aortic homograft, and a brief review of the literature on the surgical management of retrohepatic inferior vena caval tumors are discussed.

Surgical management of univentricular heart with total anomalous pulmonary venous drainage and intrapulmonary vertical vein

We report a patient with univentricular heart, heterotaxy syndrome with total anomalous pulmonary venous connection, and an intrapulmonary vertical vein draining into the left superior vena cava who underwent a successful bidirectional Glenn shunt without cardiopulmonary bypass. A polytetrafluoroethylene tube interposition graft was used between the superior vena cava and the pulmonary artery. This condition is unusual and physiologic palliation, rather than anatomic correction as described in this report, may be appropriate for managing this condition.

Use of Aortic Homograft Conduit in Bidirectional Glenn Shunt

We present our experience with a patient in whom a homograft conduit was used to connect the superior vena cava (SVC) to the right pulmonary artery (RPA) in a functionally univentricular heart where corrective repair was impossible.

Endovascular stenting of nonmalignant superior vena cava syndrome

Superior vena cava (SVC) syndrome is associated with advanced malignancy of the chest. Extensive experience is published in the literature regarding the use of endovascular intervention for symptomatic relief in these individuals with limited survival. Symptomatic SVC obstruction may occur from benign conditions that may not alter life expectancy. There are few data regarding endovascular therapy in this setting. We retrospectively analyzed our experience using endovascular intervention for benign SVC obstruction in 19 patients. In our series, the mean age was 46.4 years; 58% were female and 14/19 cases were due to an intravascular device. All patients experienced symptomatic relief. Median follow-up was 28.8 months. Three patients required secondary procedures to maintain patency. Four patients had procedural complications, which did not affect the outcomes. One patient died from complications of anticoagulation at 24 months. Endovascular procedures aimed at relieving SVC stenosis seem to be effective in patients with benign disease.