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Yankov G, Alexieva M, Mekov E, Petkov R. Resection and a rare type of reconstruction of the superior vena cava with the left brachiocephalic vein. Folia Med (Plovdiv) 2024; 66:142-146. [PMID: 38426478 DOI: 10.3897/folmed.66.e102981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/13/2023] [Indexed: 03/02/2024] Open
Abstract
Resection and reconstruction of the superior vena cava (SVC) are required in a selected group of patients with anterior mediastinal tumors and lung neoplasms. We present the case of a 63-year-old woman who underwent invasive type B2 thymoma resection and a rare type of reconstruction of the superior vena cava using a patch of the left brachiocephalic vein (LBV). The various types of reconstruction of the superior vena cava are discussed.
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Miyamoto S, Hidaka T, Fukuoka O, Fujisawa K, Okazaki M. Internal jugular vein reconstruction using a triple-paneled great saphenous vein graft. World J Surg Oncol 2023; 21:10. [PMID: 36647096 PMCID: PMC9841726 DOI: 10.1186/s12957-023-02902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Donor-recipient diameter discrepancy can be problematic when using an autologous great saphenous vein graft for internal jugular vein reconstruction. A triple-paneled method of saphenous vein grafting is one solution. CASE PRESENTATION A 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. An 8-cm segment of the right internal jugular vein was resected. For reconstruction, a 30-cm segment of the great saphenous vein was harvested and divided into three pieces of equal length. After opening each piece longitudinally, they were sutured together in a side-by-side fashion to create a cylinder that was used to reconstruct the internal jugular vein defect. The graft was patent 10 months after the surgery. CONCLUSION The triple-paneled method is feasible for autologous great saphenous vein graft reconstruction of the internal jugular vein.
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Affiliation(s)
- Shimpei Miyamoto
- grid.26999.3d0000 0001 2151 536XDepartment of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Takeaki Hidaka
- grid.26999.3d0000 0001 2151 536XDepartment of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Osamu Fukuoka
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kou Fujisawa
- grid.26999.3d0000 0001 2151 536XDepartment of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Mutusmi Okazaki
- grid.26999.3d0000 0001 2151 536XDepartment of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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SEN I, KALRA M, GLOVICZKI P. Interventions for superior vena cava syndrome. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:674-681. [DOI: 10.23736/s0021-9509.22.12448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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4
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Shin DS, Jackson TR, Bertino FJ, Monroe EJ, Hage AN, Lee E, Ingraham CR, Vaidya S, Chick JFB. Kissing Viabahn VBX stent graft reconstruction of thoracic central veins for management of superior vena cava syndrome. J Vasc Surg Venous Lymphat Disord 2022; 10:1279-1287.e1. [PMID: 35843595 DOI: 10.1016/j.jvsv.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In the present study, we evaluated the technical and clinical outcomes of thoracic central vein reconstruction for superior vena cava (SVC) syndrome using kissing Viabahn VBX stent grafts (W.L. Gore & Associates, Flagstaff, AZ). METHODS All adult patients with SVC syndrome who had undergone attempted bilateral brachiocephalic vein-to-SVC reconstruction using kissing VBX stent grafts at an academic hospital between August 2019 and February 2021 were reviewed. The technical results, adverse events, imaging follow-up findings, and clinical outcomes were recorded. Patency over time was assessed using Kaplan-Meier analysis. RESULTS A total of 28 patients (16 women and 12 men; mean age, 52.0 years) constituted the study cohort. Of the 28 patients, 17 (60.7%) had had benign and 11 (39.3%) malignant etiologies. The presenting symptoms included neck swelling (n = 17; 60.7%), bilateral upper extremity swelling (n = 15; 53.6%), dyspnea (n = 7; 25%), unilateral upper extremity swelling (n = 4; 14.3%), and dysphagia (n = 1; 3.6%). SVC reconstruction with VBX stent grafts in a kissing configuration was successfully completed in 27 of the 28 patients (96.4%). Four major adverse events were noted in the benign etiology subgroup (23.5%), including intraprocedural hemopericardium (n = 3) and delayed pneumothorax (n = 1). Of the 28 patients, 27 (96.4%) had experienced resolution of their presenting symptoms. The mean clinical follow-up for the living patients was 358.8 ± 77.2 days (range, 78-645 days). The mean imaging follow-up for the living patients was 272.6 ± 91 days (range, 26-594 days). The primary, primary-assisted, and secondary patency rates at 12 months were 71.8%, 88.8%, and 100%, respectively. CONCLUSIONS For the management of SVC syndrome, thoracic central vein reconstruction with kissing VBX stent grafts was feasible with a high rate of symptom resolution and acceptable patency. However, this technique should not be recommended for those with benign SVC syndrome owing to the high risk of cardiac tamponade.
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Affiliation(s)
- David S Shin
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA; The Deep Vein Institute, University of Washington, Seattle, WA.
| | - Tyler R Jackson
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Frederic J Bertino
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Eric J Monroe
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, WI
| | - Anthony N Hage
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Eunjee Lee
- Department of Information and Statistics, Chungnam National University, Daejeon, South Korea
| | - Christopher R Ingraham
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Sandeep Vaidya
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA
| | - Jeffrey Forris Beecham Chick
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA; The Deep Vein Institute, University of Washington, Seattle, WA
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Inoue T, Fujii K, Kaneda T, Kitayama H. Mid-Term Patency of Spiral Saphenous Vein Graft for Malignant Superior Vena Cava Syndrome. Vasc Endovascular Surg 2022; 56:817-819. [PMID: 35961606 DOI: 10.1177/15385744221121205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reports documenting the mid-term patency of spiral saphenous vein grafts for superior vena cava syndrome in patients with advanced thoracic malignancy are, so far, scarce. The present report describes a 69-year-old man who suffered superior vena cava syndrome due to malignant invasion by advanced lung cancer. Since the huge mass in the anterior mediastinum was unresectable, a bypass from the left innominate vein to the right atrium using an autologous spiral saphenous vein graft was surgically created. Postoperatively, the patient received chemoradiotherapy and maintenance anticoagulant therapy, resulting in survival for 4 years without graft occlusion or recurrence of superior vena cava syndrome.
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Affiliation(s)
- Takehiro Inoue
- Department of Cardiovascular Surgery, 145696Mimihara General Hospital, Osaka, Japan
| | - Kosuke Fujii
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Osaka, Japan
| | - Toshio Kaneda
- Department of Cardiovascular Surgery, 145696Mimihara General Hospital, Osaka, Japan
| | - Hitoshi Kitayama
- Department of Cardiovascular Surgery, 145696Mimihara General Hospital, Osaka, Japan
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Ponti A, Saltiel S, Rotzinger DC, Qanadli SD. Insights Into Endovascular Management of Superior Vena Cava Obstructions. Front Cardiovasc Med 2021; 8:765798. [PMID: 34901225 PMCID: PMC8652054 DOI: 10.3389/fcvm.2021.765798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Superior vena cava obstruction results from any limitation of blood flow through the superior vena cava. Circulation to the heart may persist through various collateral vessels whose development depends on the level of obstruction. Depending on the level and degree of occlusive disease, the severity of clinical symptoms may vary considerably, up to lethal. Etiologies have changed dramatically in recent years, mainly due to the increasing use of intravascular devices. However, guidelines for treatment are lacking, and various options are available. Endovascular therapies developed considerably in recent years, may offer a rapid improvement in symptoms and proved to be safe. However, knowledge and selection of appropriate techniques are essential to venous angioplasty, involving specific tools to guarantee satisfying outcomes. This review aims to discuss the particular venous anatomy of the upper body, the physiopathology of superior vena cava obstruction, and specificities of endovascular treatment compared with other management options.
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Affiliation(s)
- Alexandre Ponti
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Sarah Saltiel
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - David C Rotzinger
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
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7
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Chen W, Lei J, Wang Y, Tang X, Liu B, Li Z, Zhou Q. Case Report: Superior Vena Cava Resection and Reconstruction for Invasive Thyroid Cancer: Report of Three Cases and Literature Review. Front Surg 2021; 8:644605. [PMID: 34141718 PMCID: PMC8204692 DOI: 10.3389/fsurg.2021.644605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Thyroid cancer with massive invasion into the cervical and mediastinal great veins is extremely rare, and the surgical treatment is controversial, thus posing a great challenge for head and neck surgeons. Here, we report our successful experiences in reconstructing the superior vena cava (SVC) system to treat thyroid cancer with an extensive tumor thrombus growing intraluminally into the SVC. Case Presentation: From September 2019 to September 2020, three patients with superior vena cava syndrome(SVCS) caused by tumor thrombus invasion from thyroid cancer were continuously included in this series. After preoperative evaluation, radical resection and reconstruction of the SVC system with expanded polytetrafluoroethylene (EPTFE) grafts were performed. In addition, bypass support from the right internal jugular vein to the right femoral vein was routinely prepared intraoperatively to prevent a rise in central venous pressure (CVP). Postoperatively, SVC-related syndrome improved immediately after the operation. Imaging examination showed good function of the reconstructed venous system. The patients recovered well with no surgical complications and remain under continuous follow-up. Conclusions: Tumor growth into the SVC does not seem to be an absolute contraindication for surgery for thyroid carcinoma. Comprehensive treatment, including reconstruction of the SVC, is effective for relieving symptoms and preventing disease progression and is thus worth advocating. In addition, bypass support from the internal jugular vein to the femoral vein is easy to implement and can improve the safety of the operation.
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Affiliation(s)
- Wenjie Chen
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yichao Wang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaojun Tang
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
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Kumar A, Pulle MV, Asaf BB, Shivnani G, Maheshwari A, Kodaganur SG, Puri HV, Bishnoi S. Superior Vena Cava Resection in Locally Advanced Thymoma-Surgical and Survival Outcomes. Indian J Surg Oncol 2020; 11:711-719. [PMID: 33299285 DOI: 10.1007/s13193-020-01204-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
This study was aimed at reporting the surgical management of superior vena cava invasion in patients with locally advanced thymoma and to evaluate surgical and survival outcomes. This is a retrospective analysis of 12 patients operated for superior vena cava resection for locally advanced thymoma over 8 years in a thoracic surgery centre in India. An analysis of peri-operative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Intra-operatively, superior vena cava (SVC) alone was involved in 3 (25%) cases, SVC with BCV involvement was there in 8 cases (66.7%) and in 1 patient, the SVC involvement extended into the right atrium also. In all cases, the tumour was resected en bloc with the involved part of SVC. Repair with primary closure was sufficient in 2 cases (16.6%) in view of < 1/3rd of circumferential involvement. However, in remaining 10 cases, SVC was replaced with PTFE graft (single graft in 6 cases, Y-graft in 2 cases and twin grafts in 2 cases). No peri-operative deaths. Overall survival (OS) at 1, 3 and 5 years was 100%, 91.6% and 83.3%, respectively. Myasthenia gravis and higher Masaoka stage (IV A) of the disease were poor predictors of survival. Superior vena cava resection and reconstruction is a feasible and oncologically superior option in invasive thymoma with SVC involvement. This challenging surgical procedure should only be attempted by an experienced team of thoracic and cardiac surgeons at high-volume centre to achieve best outcomes.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Ganesh Shivnani
- Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Arun Maheshwari
- Department of Cardiac Anaesthesia, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
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Kilcoyne MF, Do-Nguyen CC, Moulick A, Madan N, Mahan V, Conley S, Brady PS, Endean ED, Stevens RM. Left innominate vein creation using left internal jugular vein tunneled to right internal jugular vein. J Card Surg 2020; 35:2370-2374. [PMID: 32652646 DOI: 10.1111/jocs.14654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left innominate vein occlusion is a known complication of pacemaker and central venous catheter placement. For dialysis-dependent patients with an arteriovenous fistula (AVF), this can prevent successful hemodialysis and may require surgical intervention. CASE REPORT An 8-month-old male was diagnosed with hemolytic uremic syndrome and became dialysis-dependent at 11 months of age. After multiple vascular access and peritoneal dialysis complications, the patient had construction of a brachiobasalic AVF in his left arm at 13 years old. While waiting for the AVF to mature, an attempt to remove a previously placed left subclavian vein port-a-cath was unsuccessful and a follow-up imaging revealed that the vessel had become occluded. The fistula remained patent, but due to arm swelling and venous obstruction, his fistula was not accessible. Multiple attempts to percutaneously cross the left innominate vein were unsuccessful and the patient was referred for surgical intervention. At 15 years old, the patient was taken to the operating room for transposition of the left internal jugular vein (LIJ) to the right internal jugular vein (RIJ). The LIJ was transected under the mandible and anastomosed to the RIJ. Subsequently the patient underwent VWING insertion rather than venous transposition for constant site dialysis. Although he has required frequent transcatheter dilation of the LIJ-RIJ anastomosis, the patient was successfully dialyzed using this fistula for 5 years. The patient received a cadaveric renal transplant at 5 years 20 days. CONCLUSIONS In cases of left innominate vein stenosis, transposing the LIJ can create a new left innominate vein that can alleviate venous hypertension and preserve fistula function. This procedure avoids sternotomy and only requires one anastomosis.
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Affiliation(s)
- Maxwell F Kilcoyne
- Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Chi Chi Do-Nguyen
- Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Achintya Moulick
- Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Nandini Madan
- Department of Pediatric Cardiology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Vicki Mahan
- Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Susan Conley
- Department of Pediatric Nephrology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Paul S Brady
- Department of Cardiovascular and Interventional Radiology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Eric D Endean
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Randy M Stevens
- Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
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10
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Bai H, Wang Z, Li M, Sun P, Wei S, Wang Z, Xing Y, Dardik A. Adult Human Vein Grafts Retain Plasticity of Vessel Identity. Ann Vasc Surg 2020; 68:468-475. [PMID: 32422286 DOI: 10.1016/j.avsg.2020.04.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/14/2020] [Accepted: 04/18/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The spiral saphenous vein graft is an excellent choice for venous reconstruction after periphery vein injury, but only few cases have been reported. We implanted a segment of a single saphenous vein into both the popliteal vein as a venous vein graft and into the popliteal artery as an arterial vein graft at the same time in a trauma patient; we then had an extraordinary opportunity to harvest and examine both patent venous and arterial vein grafts at 2 weeks after implantation. METHODS A spiral saphenous vein graft was made as previously described and implanted into the popliteal vein and artery as interposition grafts; because of the patient's serious injuries, an amputation was performed at day 18 after vascular reconstruction. The grafts were harvested, fixed, and examined using histology and immunohistochemistry. RESULTS Both grafts were patent, and there was a larger neointimal area in the venous graft compared to the arterial graft. There were CD31- and vWF-positive cells on both neointimal endothelia, with subendothelial deposition of α-actin-, CD3-, CD45-, and CD68-positive cells. There were fewer cells in the venous graft neointima compared to the arterial graft neointima; however, there were more inflammatory cells in the neointima of the venous graft. Some of the neointimal cells were PCNA-positive, whereas very few cells were cleaved caspase-3 positive. The venous graft neointimal endothelial cells were Eph-B4 and COUP-TFII positive, while the arterial graft neointimal endothelial cells were dll-4 and Ephrin-B2 positive. CONCLUSIONS The spiral saphenous vein graft remains a reasonable choice for vessel reconstruction, especially in the presence of diameter mismatch. Both the venous and arterial grafts showed similar re-endothelialization and cellular deposition; the venous graft had more neointimal hyperplasia and inflammation. At an early time, endothelial cells showed venous identity in the venous graft, whereas endothelial cells showed arterial identity in the arterial graft. CLINICAL RELEVANCE Veins can be used as venous or arterial vein grafts but venous grafts have more neointimal hyperplasia and inflammation; vein grafts acquire different vessel identity depending on the environment into which they are implanted.
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Affiliation(s)
- Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China; Department of Physiology, Medical School of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Zhiwei Wang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Mingxing Li
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Peng Sun
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shunbo Wei
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhiju Wang
- Key Vascular Physiology and Applied Research Laboratory, Zhengzhou, Henan, People's Republic of China; Department of Physiology, Medical School of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ying Xing
- Key Vascular Physiology and Applied Research Laboratory, Zhengzhou, Henan, People's Republic of China; Department of Physiology, Medical School of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Alan Dardik
- The Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT; Department of Surgery and Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT.
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De Clercq E, Martens A, Matthys H, Wiemer P, Ugahary F, van Loon G. Partial aneurysmectomy and autologous patch venoplasty in a horse diagnosed with pseudoaneurysm of the jugular vein. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. De Clercq
- Department of Surgery and Anaesthesiology Ghent University Merelbeke Belgium
| | - A. Martens
- Department of Surgery and Anaesthesiology Ghent University Merelbeke Belgium
| | - H. Matthys
- Department of Large Animal Internal Medicine Ghent University Merelbeke Belgium
| | - P. Wiemer
- De Lingehoeve Diergeneeskunde Lienden The Netherlands
| | - F. Ugahary
- Consultant in General Surgery Tiel The Netherlands
| | - G. van Loon
- Department of Large Animal Internal Medicine Ghent University Merelbeke Belgium
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12
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Gray L, Alnajar A, Lamelas J. A Synthetic CardioCel Tube for Minimally Invasive Superior Vena Cava Bypass. Ann Thorac Surg 2019; 108:e283-e285. [DOI: 10.1016/j.athoracsur.2019.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 11/27/2022]
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13
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Wang ZS, Li CW, Li JX, Wu WJ, Li Y, Shi JG. Covered versus uncovered stent insertion for malignant superior vena cava obstruction. MINIM INVASIV THER 2019; 29:353-358. [PMID: 31430213 DOI: 10.1080/13645706.2019.1653925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose: To determine whether covered or uncovered stent insertion achieved better clinical efficacy when used to treat malignant superior vena cava (SVC) obstruction (SVCO).Material and methods: A total of 64 patients with malignant SVCO underwent stent insertion between January 2011 and March 2018 at our center. Of these, 34 were treated via uncovered stent insertion while 30 were treated via covered stent insertion. We compared the clinical effectiveness, patency of the stent, and overall survival between these two groups.Results: Both treatments achieved a 100% technical and clinical success rate, without any incidence of complications relating to the procedure. Stent dysfunction was found in one and six patients in the covered and uncovered groups during the follow-up period (1/30 vs. 6/34, p = .153), respectively. The covered stent patency period was significantly longer in the group treated with covered stents (374 vs. 317 days, p = .049), while median survival following stent insertion was 175 and 159 days, respectively, for the covered and uncovered groups (p = .784).Conclusion: Uncovered and covered stent insertion are both safe means of effectively treating patients with malignant SVCO, but covered stents achieve better patency for long-term periods than uncovered stents.
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Affiliation(s)
- Zi-Shan Wang
- Department of Thoracic Surgery, Ningbo First Hospital, Zhejiang, China
| | - Chen-Wei Li
- Department of Thoracic Surgery, Ningbo First Hospital, Zhejiang, China
| | - Jian-Xin Li
- Department of Thoracic Surgery, Ningbo First Hospital, Zhejiang, China
| | - Wei-Jie Wu
- Department of Thoracic Surgery, Ningbo First Hospital, Zhejiang, China
| | - Yu Li
- Department of Radiology, Xuzhou Central Hospital, Jiangsu, China
| | - Jian-Guang Shi
- Department of Thoracic Surgery, Ningbo First Hospital, Zhejiang, China
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14
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Wooster M, Fernandez B, Summers KL, Illig KA. Surgical and endovascular central venous reconstruction combined with thoracic outlet decompression in highly symptomatic patients. J Vasc Surg Venous Lymphat Disord 2019; 7:106-112.e3. [DOI: 10.1016/j.jvsv.2018.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/31/2018] [Indexed: 10/27/2022]
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15
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Gwozdz AM, Silickas J, Smith A, Saha P, Black SA. Endovascular Therapy for Central Venous Thrombosis. Methodist Debakey Cardiovasc J 2018; 14:214-218. [PMID: 30410652 DOI: 10.14797/mdcj-14-3-214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Central vein thrombosis is defined as thrombosis of the major vessels draining either the upper or lower extremities. It presents most commonly in the upper limb, where it affects the subclavian veins and the superior vena cava; in the lower limb, it affects the common iliac veins and the inferior vena cava. These different anatomical segments pose unique challenges in both acute and chronic settings, and this article will summarize the current best practice treatment options.
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Ketenciler S, Boyacıoğlu K, Akdemir İ, Kömürcü G, Polat A. Autologous Saphenous Vein Panel Graft for Vascular Reconstruction. Ann Vasc Surg 2018; 53:117-122. [PMID: 30053553 DOI: 10.1016/j.avsg.2018.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/14/2018] [Accepted: 05/01/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study aims to present early and midterm results of vascular reconstruction with saphenous vein panel graft. METHODS Between August 2014 and August 2017, 11 saphenous vein panel grafts were used for vascular reconstruction in 10 patients. Patient data including age, gender, etiology of the vascular pathology, concomitant injury, site of injury, surgical procedure, additional surgical procedure, and hemodynamic status were retrospectively collected and analyzed. The Kaplan-Meier method was used to calculate the reintervention and patency rates. RESULTS Mean duration of follow-up was 16.5 ± 13.2 months (ranged, 2-39 months). The freedom from reintervention for any reason was 82% at 1 and 2 years. There was no evidence of arterial claudication or venous insufficiency in all patients. The primary patency rates were 82% at 1 and 2 years. There was no mortality, deep venous thrombosis, pulmonary embolism, graft thrombosis, anastomotic stenosis, diameter discrepancy, and aneurysm formation during late follow-up. CONCLUSIONS The autologous saphenous panel vein graft enables the surgeon to prepare suitable conduits easily with an appropriate diameter and length for vascular reconstruction. Although long-term results are unknown, this technique provides high patency rates in midterm follow-up, resistance to infection, and low reintervention rates. In conclusion, autologous saphenous vein panel grafts may well be preferred in various vascular disorders that require surgical reconstruction.
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Affiliation(s)
- Serkan Ketenciler
- Cardiovascular Surgery Department, University of Health Sciences, Bağcılar Research and Training Hospital, Istanbul, Turkey
| | - Kamil Boyacıoğlu
- Cardiovascular Surgery Department, University of Health Sciences, Bağcılar Research and Training Hospital, Istanbul, Turkey.
| | - İlknur Akdemir
- Cardiovascular Surgery Department, University of Health Sciences, Bağcılar Research and Training Hospital, Istanbul, Turkey
| | - Gürkan Kömürcü
- Cardiovascular Surgery Department, University of Health Sciences, Bağcılar Research and Training Hospital, Istanbul, Turkey
| | - Adil Polat
- Cardiovascular Surgery Department, University of Health Sciences, Bağcılar Research and Training Hospital, Istanbul, Turkey
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18
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Haddad MM, Simmons B, McPhail IR, Kalra M, Neisen MJ, Johnson MP, Stockland AH, Andrews JC, Misra S, Bjarnason H. Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction. Cardiovasc Intervent Radiol 2018; 41:712-717. [PMID: 29492630 DOI: 10.1007/s00270-018-1906-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/17/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction. METHODS AND MATERIALS We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis. Covered stents were placed in 17 (36%) of the patients, and 30 (64%) patients had an uncovered stent. Clinical and treatment outcomes, complications, and the percent stenosis of each stent were evaluated. RESULTS Technical success was achieved in all cases at first attempt. Average clinical and imaging follow-up in years was 2.7 (range 0.1-11.1) (covered) and 1.7 (range 0.2-10.5) (uncovered), respectively. There was a significant difference (p = 0.044) in the number of patients who reported a return of symptoms between the covered (5/17 or 29.4%) and uncovered (18/30 or 60%) groups. There was also a significant difference (p = < 0.001) in the mean percent stenosis after stent placement between the covered [17.9% (range 0-100) ± 26.2] and uncovered [48.3% (range 6.8-100) ± 33.5] groups. No significant difference (p = 0.227) was found in the time (days) between the date of the procedure and the date of clinical follow-up where a return of symptoms was reported [covered: 426.6 (range 28-1554) ± 633.9 and uncovered 778.1 (range 23-3851) ± 1066.8]. One patient in the uncovered group had non-endovascular surgical intervention (innominate to right atrial bypass), while none in the covered group required surgical intervention. One major complication (SIR grade C) occurred that consisted of a pericardial hemorrhagic effusion after angioplasty that required covered stent placement. There were no procedure-related deaths. CONCLUSION Both covered and uncovered stents can be used for treating benign SVC syndrome. Covered stents, however, may be a more effective option at providing symptom relief and maintaining stent patency if validated by further studies.
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Affiliation(s)
- Mustafa M Haddad
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA.
| | - Benjamin Simmons
- Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Ian R McPhail
- Departments of Cardiology and Vascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Manju Kalra
- Department of Vascular Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Melissa J Neisen
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Matthew P Johnson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Andrew H Stockland
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - James C Andrews
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Sanjay Misra
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
| | - Haraldur Bjarnason
- Department of Radiology, Mayo Clinic, 200 1st St SW, Mayo - West 2, Rochester, MN, 55905, USA
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Primary Stenting Is Not Necessary in Benign Central Venous Stenosis. Ann Vasc Surg 2017; 46:322-330. [PMID: 28807744 DOI: 10.1016/j.avsg.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/09/2017] [Accepted: 07/17/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate central venous stenosis (CVS) etiologies and presentation within a vascular surgery practice. We evaluated endovascular treatment modalities and the patency rates of our interventions. METHODS Five-year retrospective review of endovascular intervention for CVS. Patient demographics, medical comorbidities, and variables were collected including etiology, indwelling device, previous upper extremity (UE) deep venous thrombosis, long-term UE indwelling device (defined as >30 days), malignancy status, hypercoagulable disorders, history of radiation or mediastinal fibrosis or masses, and anticoagulation and/or antiplatelet therapy. Follow-up variables included symptoms, imaging, and anticoagulation and/or antiplatelet utilization. Living patients without recent follow-up were contacted with a telephone survey regarding current symptoms. Patency was evaluated by imaging or clinically by recurrence of signs or symptoms through January 2016. RESULTS A total of 61 patients underwent attempted endovascular CVS interventions from January 2007 to 2013. Forty-seven (83%) patients had successful interventions. There were 22 (36%) end-stage renal disease (ESRD) patients. The primary etiology in 79% of patients was benign CVS secondary to an indwelling device. Eighty-nine percent of the interventions were primary angioplasty (PTA). The overall primary patency rates at 6, 12, and 24 months were 49%, 34%, and 24%, respectively. Secondary patency rates at 6, 12, and 24 months were 97%, 93%, and 88%, respectively. There were no statistical differences in demographics or outcomes in patients treated successfully with PTA or those requiring stenting. There was no statistical difference in the patency rates between ESRD and non-ESRD patients. Previous interventions were not a predictor of loss of patency. CONCLUSIONS Our study supported the rising trend of benign CVS predominantly secondary to indwelling devices. We demonstrated acceptable secondary patency with PTA alone. This study adds further support for a primary angioplasty strategy in treating benign CVS. The optimal endovascular treatment for benign CVS is still undefined.
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Abu-Omar Y, Kocher GJ, Bosco P, Barbero C, Waller D, Gudbjartsson T, Sousa-Uva M, Licht PB, Dunning J, Schmid RA, Cardillo G. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg 2017; 51:10-29. [PMID: 28077503 DOI: 10.1093/ejcts/ezw326] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/24/2022] Open
Abstract
Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.
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Affiliation(s)
- Yasir Abu-Omar
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Gregor J Kocher
- Division of General Thoracic Surgery, Bern University Hospital / Inselspital, Switzerland
| | - Paolo Bosco
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, University of Turin-Italy, Città della Salute e della Scienza-San Giovanni Battista Hospital, Torino, Italy
| | - David Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Miguel Sousa-Uva
- Unit of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Ralph A Schmid
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera S. Camillo Forlanini, Lazzaro Spallanzani Hospital, Rome, Italy
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Zubair MM, Duran CA, Peden EK. Superior Vena Cava Reconstruction Using Femoropopliteal Vein as a Panel Graft. Ann Vasc Surg 2017; 44:414.e15-414.e18. [PMID: 28479442 DOI: 10.1016/j.avsg.2017.03.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/01/2017] [Indexed: 11/16/2022]
Abstract
There has been an increase in superior vena cava (SVC) syndrome secondary to the growing use of indwelling catheters and pacemaker wire insertions. These 2 factors can account up to 74% cases of benign SVC syndrome. Endovascular therapy is considered the first line of treatment. Surgery is an excellent option and is generally reserved for SVC syndrome not amenable to traditional endovascular procedures. We report a case of central venous reconstruction including an SVC reconstruction using the femoropopliteal vein as a panel graft in a patient with SVC syndrome due to pacemaker wires who failed multiple endovascular interventions.
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Affiliation(s)
- M Mujeeb Zubair
- Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX.
| | - Cassidy A Duran
- Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX
| | - Eric K Peden
- Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX
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22
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Sun Y, Gu C, Shi J, Fang W, Luo Q, Hu D, Fu S, Pan X, Chen Y, Yang Y, Yang H, Zhao H, Chen H. Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases. J Thorac Dis 2017; 9:725-733. [PMID: 28449480 DOI: 10.21037/jtd.2017.03.03] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Discuss an appropriate strategy for treatment of invasive thymoma invading adjacent great vessels. METHODS A retrospective study on 25 patients with invasive thymoma invading neighboring great vessels was performed. The corresponding data including clinical presentation, operation procedure, adjuvant radio-chemotherapy and follow-up were reviewed. RESULTS Twenty of 25 (80%) patients with invasive thymoma underwent complete resection of the tumor along with vessel reconstruction. Intraoperatively, different types of operation were conducted, namely, brachiocephalic vein (BCV)-right atrial appendage (RAA) reconstruction in 11 cases, complex vessel reconstruction (more than one graft) in 1 case and superior vena cava (SVC)-SVC reconstruction in the remaining cases. Ringed polytetrafluoroethylene (PTFE) grafts were used for vessel reconstruction. Postoperatively, three cases suffered from pulmonary infection, and three cases had haemothorax, chylothorax and atelectasis, respectively. Two patients died due to acute respiratory distress syndrome within 90 days after the surgery. Within the remaining patients, 11 cases (44%) experienced a relapse and finally 8 (32%) patients died. Compared to R1 resection group, R0 resection group had a better prognosis (Log-rank P=0.0196). The 3- and 5-year survival rates were 79.6% and 59.1%, with median survival time of 84 months. CONCLUSIONS Reconstruction of mediastinal vessels for invasive thymoma is a feasible technology method. Radical resection of the tumor with involved neighboring structures is the key to prolong overall survival for patients suffered from invasive thymoma.
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Affiliation(s)
- Yifeng Sun
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Dingzhong Hu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Shijie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yong Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yu Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Superior Vena Cava Syndrome Caused by Pacemaker Leads. Ann Thorac Surg 2017; 101:2358-61. [PMID: 27211943 DOI: 10.1016/j.athoracsur.2015.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/04/2015] [Accepted: 09/04/2015] [Indexed: 02/07/2023]
Abstract
Superior vena cava syndrome is one of the rare adverse events associated with pacemaker leads. We describe a 47-year-old woman with a pacemaker implanted 10 years earlier who presented to us with superior vena cava syndrome managed surgically. We report the presentation, diagnosis, and treatment of this patient and the causes and management options of superior vena cava obstruction associated with pacemaker leads.
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A Review of Open and Endovascular Treatment of Superior Vena Cava Syndrome of Benign Aetiology. Eur J Vasc Endovasc Surg 2016; 53:238-254. [PMID: 28007450 DOI: 10.1016/j.ejvs.2016.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/13/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND The widespread use of central venous catheters, ports, pacemakers, and defibrillators has increased the incidence of benign superior vena cava syndrome (SVCS). This study aimed at reviewing the results of open and endovascular treatment of SVCS. METHOD Medical literature databases were searched for relevant studies. Studies with more than five adult patients, reporting separate results for the SVC were included. Nine studies reported the results of endovascular treatment of SVCS including 136 patients followed up for a mean of 11-48 months. Causes of SVCS were central venous catheters and pacemakers (80.6%), mediastinal fibrosis (13.7%), and other (5.6%). Percutaneous transluminal angioplasty (PTA) and stenting was performed in 73.6%, PTA only in 17.3%, and thrombolysis, PTA, and stenting in 9%. Four studies reported the results of open repair of SVCS including 87 patients followed up between 30 months and 10.9 years. The causes were mediastinal fibrosis (58.4%), catheters and pacemakers (28.5%), and other (13%). Operations performed included a spiral saphenous interposition graft, other vein graft, PTFE graft, and human allograft. Thirteen patients required re-operations (15%) before discharge mainly for graft thrombosis. RESULTS In the endovascular group technical success was 95.6%. Thirty day mortality was 0%. Regression of symptoms was reported in 97.3%. Thirty-two patients (26.9%) underwent 58 secondary procedures. In the open group the 30 day mortality was 0%. Symptom regression was reported in 93.5%. Twenty-four patients (28.4%) underwent a total of 33 secondary procedures. CONCLUSIONS Endovascular is the first line treatment for SVCS caused by intravenous devices, whereas surgery is most often performed for mediastinal fibrosis. Both treatments show good results regarding regression of the symptoms and mid-term primary patency, with a significant incidence of secondary interventions.
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Dinkel HP, Mettke B, Schmid F, Baumgartner I, Triller J, Do DD. Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Is Bilateral Wallstent Placement Superior to Unilateral Placement? J Endovasc Ther 2016; 10:788-97. [PMID: 14533962 DOI: 10.1177/152660280301000416] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report our experience with unilateral versus bilateral stent placement in the treatment of malignant superior vena cava syndrome (SVCS). Methods: The records and films of 84 consecutive patients (69 men; mean age 64±10 years, range 39–79) referred for stent placement in malignant SVCS were reviewed for venous compromise, technical and clinical success, complications, and reocclusions. Wallstents were placed covering the SVC and both (bilateral technique) brachiocephalic veins (BCV) preferentially; unilateral stenting of only one BCV in addition to the SVC was performed based on operator preference or inability to access both sides. Technical success was defined as the ability to stent the SVC and at least one BCV; clinical success was the elimination of SVCS symptoms. Results: Technical success was achieved in 83 (99%) patients, using the unilateral technique in 22 and bilateral stenting in 61 patients. The groups did not differ with regard to age, sex, underlying diseases, or location and extent of venous compromise. Immediate clinical success was achieved in 20 (91%) of 22 patients in the unilateral group and 55 (90%) of 61 patients in the bilateral group. Two patients suffered late occlusion in the unilateral group, while in the bilateral group, 8 patients had early occlusion and 9 had late occlusion. Thus, the total occlusion rate was significantly (p<0.05) lower in the unilateral group. There was 1 other complication (pericardial tamponade) in the bilateral group, for a 28% total complication rate, which was significantly higher (p = 0.039) than the 9% in the unilateral group. The 1, 3, 6, and 12-month primary stent patency rates were 90%, 81%, 76%, and 69%, respectively. Patency tended to last longer in the unilateral group, but the difference was not significant (p = 0.11). Conclusions: Although bilateral Wallstent placement achieved equal technical and clinical success, it tended to confer shorter-lived patency and caused more complications.
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Affiliation(s)
- Hans-Peter Dinkel
- Department of Diagnostic Radiology, Inselspital, University Hospital of Berne, Switzerland.
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Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes : long-term follow-up. Eur Radiol 2016; 27:97-104. [DOI: 10.1007/s00330-016-4354-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Veshti A, Prifti E, Ballerini L, Vanini V. Endovascular treatment of superior vena cava obstruction after surgical correction of intracardiac total anomalous pulmonary venous connection. World J Pediatr Congenit Heart Surg 2015; 6:288-90. [PMID: 25870349 DOI: 10.1177/2150135114563940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A three-month-old infant operated for obstructed intracardiac total anomalous pulmonary venous connection was readmitted because of sinus bradycardia and superior vena cava syndrome. Cardiac catheterization revealed a stenosis at the superior vena cava-right atrial junction with retrograde azygos flow. Following balloon dilatation of the stenotic area and stent implantation, the superior vena cava syndrome was rapidly relieved. At six months, an echocardiogram confirmed unobstructed flow from the superior vena cava to the right atrium.
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Affiliation(s)
- Altin Veshti
- Division of Cardiovascular Surgery, University Hospital Center of Tirana, Albania
| | - Edvin Prifti
- Division of Cardiovascular Surgery, University Hospital Center of Tirana, Albania
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Korkmaz K, Gedik HS, Yalçınkaya A, Yener AÜ, Diken Aİ, Çağlı K. Use of a superficial femoral artery autograft as a femoral vein replacement. Ann Vasc Surg 2014; 29:364.e19-21. [PMID: 25463332 DOI: 10.1016/j.avsg.2014.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/30/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
Posttraumatic arteriovenous fistulas (AVFs) are common complications of vascular penetrating trauma. Here we present a case of a 59-year-old woman who had a history of gunshot injury 42 years ago causing AVF between superficial femoral artery (SFA) and superficial femoral vein (SFV). SFV was resected. Ipsilateral SFA was used to restore SFV. SFA was reconstituted using a 7-mm polytetrafluorethylene graft. The patient has normal venous and arterial flow at 3- and 15-month follow-up.
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Affiliation(s)
- Kemal Korkmaz
- Department of Cardiovascular Surgery, Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Hikmet Selçuk Gedik
- Department of Cardiovascular Surgery, Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Adnan Yalçınkaya
- Department of Cardiovascular Surgery, Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi, Çorum, Türkiye.
| | - Ali Ümit Yener
- Department of Cardiovascular Surgery, Numune Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Adem İlkay Diken
- Department of Cardiovascular Surgery, Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi, Çorum, Türkiye
| | - Kerim Çağlı
- Department of Cardiovascular Surgery, Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi, Çorum, Türkiye
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de Chaumont A, Pierret C, de Kerangal X, Le Moulec S, Laborde F. Leiomyosarcoma of the superior vena cava. Ann Thorac Surg 2014; 98:725-7. [PMID: 25087805 DOI: 10.1016/j.athoracsur.2013.09.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 08/28/2013] [Accepted: 09/30/2013] [Indexed: 10/25/2022]
Abstract
Leiomyosarcoma of the superior vena cava is a very rare tumor and only a few cases have been reported, with various techniques of vascular reconstruction. We describe a new case of leiomyosarcoma of the superior vena cava in a 61-year-old woman with extension to the brachiocephalic arterial trunk. Resection and vascular reconstruction were performed using, respectively, polytetrafluoroethylene and polyethylene terephtalate vascular grafts.
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Affiliation(s)
- Arthus de Chaumont
- Department of Vascular Surgery, Military Hospital Val-de-Grâce, Paris, France.
| | - Charles Pierret
- Department of Vascular Surgery, Military Hospital Val-de-Grâce, Paris, France
| | - Xavier de Kerangal
- Department of Vascular Surgery, Military Hospital Val-de-Grâce, Paris, France
| | | | - François Laborde
- Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France
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Otani S, Westall GP, Levvey BJ, Marasco S, Lyon S, Snell GI. Managing central venous obstruction in cystic fibrosis recipients--lung transplant considerations. J Cyst Fibros 2014; 14:255-61. [PMID: 25174332 DOI: 10.1016/j.jcf.2014.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The superior vena cava (SVC) syndrome in cystic fibrosis (CF) patients is rare, but presents unique challenges in the peri-transplant period. We reviewed our experience of SVC syndrome in CF recipients undergoing lung transplantation. METHODS This is a retrospective case series from a single center chart-review. SVC obstruction is defined by clinically significant stenosis or obstruction of the SVC as detected by contrast studies. RESULTS We identified SVC obstruction in seven post-transplant cases and one pre-transplant case. All eight patients had previous or current history of indwelling central venous catheters. Three recipients experienced operative complications. Five of the seven recipients suffered at least one episode of post-operative SVC obstruction or bleeding despite prophylactic anticoagulation. At a median follow-up of 29 months, six of the seven patients transplanted are well. CONCLUSIONS Strategies are available to minimize the risks of intra/peri-operative acute life-threatening SVC obstruction in CF patients.
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Affiliation(s)
- Shinji Otani
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Glen P Westall
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Bronwyn J Levvey
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Stuart Lyon
- Medical Imaging Department, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Gregory I Snell
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia.
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31
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Physiological Significance of Helical Flow in the Arterial System and its Potential Clinical Applications. Ann Biomed Eng 2014; 43:3-15. [DOI: 10.1007/s10439-014-1097-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/16/2014] [Indexed: 01/12/2023]
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32
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Schade MA, Mirani NM. Fibrosing mediastinitis: an unusual cause of pulmonary symptoms. J Gen Intern Med 2013; 28:1677-81. [PMID: 23807725 PMCID: PMC3832713 DOI: 10.1007/s11606-013-2528-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/12/2013] [Accepted: 06/07/2013] [Indexed: 11/24/2022]
Abstract
Fibrosing mediastinitis (FM), also known as granulomatous or sclerosing mediastinitis, is an uncommon but serious cause of chest symptoms. Due to an infectious or inflammatory challenge, production of collagen occurs in the confined space of the mediastinum. Collagen formation leads to compression of vital structures, resulting in cough, chest pain and dyspnea. The majority of cases of FM occur as a result of prior exposure to Histoplasma capsulatum. The following is a case of a previously healthy young woman who presented with a 3-month history of cough, chest pain and trouble breathing, and was subsequently found to have fibrosing mediastinitis. Fibrosing mediastinitis should be considered in the differential diagnosis of cough, chest pain and dyspnea, primarily when findings such as increased venous pressure are present on physical exam and hilar abnormalities are seen on chest radiograph. Clinical presentation, diagnosis and management of fibrosing mediastinitis are discussed.
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Chandler JG, Chin TL, Paton BC. Polytetrafluoroethylene large vein replacements and high-altitude treks: Footnotes and footprints from Ben Eiseman's panoply of interests. J Vasc Surg Venous Lymphat Disord 2013; 1:320-3. [PMID: 26992597 DOI: 10.1016/j.jvsv.2013.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 11/30/2012] [Accepted: 01/29/2013] [Indexed: 11/25/2022]
Affiliation(s)
- James G Chandler
- Department of Surgery, the University of Colorado School of Medicine, Aurora, Colo.
| | - Theresa L Chin
- Department of Surgery, the University of Colorado School of Medicine, Aurora, Colo
| | - Bruce C Paton
- Department of Surgery, the University of Colorado School of Medicine, Aurora, Colo
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34
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Sainathan S, Andaz S. A case of pacemaker related superior venacaval syndrome after thoracic surgery. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:505-7. [PMID: 22978253 DOI: 10.1111/j.1540-8159.2012.03520.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/06/2012] [Accepted: 05/19/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York, USA.
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35
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Radio-anatomy of the superior vena cava syndrome and therapeutic orientations. Diagn Interv Imaging 2012; 93:569-77. [DOI: 10.1016/j.diii.2012.03.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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36
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Benvenuti M, Lorusso R, Gelsomino S, Benetti D, Pariscenti G, Borghesi A, Lucà F, Bovolato P. Resection of a primary leiomyosarcoma of the superior vena cava and right atrium on a beating heart. Int J Cardiol 2011; 151:e100-2. [PMID: 20961636 DOI: 10.1016/j.ijcard.2010.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 09/10/2010] [Indexed: 10/18/2022]
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37
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Glass C, Dugan M, Gillespie D, Doyle A, Illig K. Costoclavicular Venous Decompression in Patients With Threatened Arteriovenous Hemodialysis Access. Ann Vasc Surg 2011; 25:640-5. [DOI: 10.1016/j.avsg.2010.12.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/04/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
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38
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Superior vena cava bypass with cryopreserved ascending aorta allograft. Ann Thorac Surg 2011; 91:905-7. [PMID: 21353025 DOI: 10.1016/j.athoracsur.2010.08.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 07/27/2010] [Accepted: 08/30/2010] [Indexed: 11/24/2022]
Abstract
Initially superior vena cava obstruction is typically managed by an endovascular approach. However, in some patients, particularly those in whom angioplasty and stenting is not technically possible, or those who have recurrent disease after previous endovascular repair, an open surgical approach may be indicated. Conduit choices for caval reconstruction are less than ideal; hence we describe a case using a cryopreserved aortic allograft.
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Deo SV, Burkhart HM, Araoz PA, Brady PA. Innominate vein-right atrial bypass for relief of superior vena cava syndrome due to pacemaker lead thrombosis. J Card Surg 2010; 25:752-5. [PMID: 21039859 DOI: 10.1111/j.1540-8191.2010.01136.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a patient with superior vena cava (SVC) obstruction due to multiple intraluminal pacemaker leads. Previous attempts at balloon dilatation of the SVC and surgical angioplasty did not provide a long-term solution. A Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ, USA) conduit interposed between the innominate vein and right atrial appendage has resulted in symptomatic relief at a follow-up of 6 months.
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Affiliation(s)
- Salil V Deo
- Division of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota, USA
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Reconstruction of Superior Vena Cava Syndrome due to Benign Disease Using Superficial Femoral Vein. Ann Vasc Surg 2010; 24:555.e7-555.e12. [DOI: 10.1016/j.avsg.2009.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 11/10/2009] [Accepted: 12/20/2009] [Indexed: 11/19/2022]
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41
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RILEY ROBERTF, PETERSEN STEFFENE, FERGUSON JOHND, BASHIR YAVER. Managing Superior Vena Cava Syndrome as a Complication of Pacemaker Implantation: A Pooled Analysis of Clinical Practice. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:420-5. [DOI: 10.1111/j.1540-8159.2009.02613.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Radical resection of the superior vena cava using the Contegra bovine jugular vein conduit. Ann Thorac Surg 2010; 89:631-3. [PMID: 20103366 DOI: 10.1016/j.athoracsur.2009.04.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 03/20/2009] [Accepted: 04/06/2009] [Indexed: 11/21/2022]
Abstract
Radical resection of the superior vena cava poses a challenge for the cardiothoracic surgeon. The Contegra graft (Medtronic Inc, Minneapolis, MN), a biologic conduit comprising the valved segment of the bovine jugular vein, is established as a right ventricular to pulmonary artery conduit for right ventricular outflow tract repair in the pediatric population. We describe the use of the Contegra graft to facilitate radical resection and reconstruction of the superior vena cava in 2 patients, with demonstrable patency of grafts at 12 months and 7 months postoperatively.
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43
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Complex venous reconstruction: the use of a spiral vein graft at a combat support hospital. THE JOURNAL OF TRAUMA 2009; 67:E170-2. [PMID: 19901645 DOI: 10.1097/ta.0b013e31815d9b35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Brown ML, Cedeño AR, Edell ES, Hagler DJ, Schaff HV. Operative strategies for pulmonary artery occlusion secondary to mediastinal fibrosis. Ann Thorac Surg 2009; 88:233-7. [PMID: 19559232 DOI: 10.1016/j.athoracsur.2009.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 04/01/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fibrosing mediastinitis is a rare disease characterized by an excessive fibrotic reaction in the mediastinum, which may entrap mediastinal structures including the pulmonary arteries. Our objectives were to assess the surgical strategies and outcomes of repair of pulmonary artery occlusion attributable to mediastinal fibrosis. METHODS With approval from the Mayo Clinic Institutional Review Board, we identified all patients with fibrosing mediastinitis who underwent an operation for relief of pulmonary artery obstruction between 1980 and 2008. Perioperative data were collected using medical records and late follow-up surveys. RESULTS Operative procedures to bypass or reconstruct an obstructed pulmonary artery were performed in 5 patients. Patients' median age was 40 years (range, 27 to 51 years), and all patients were symptomatic and had right ventricular hypertension. In 3 patients, a double-outlet right ventricle was constructed using a valved conduit (porcine valved conduit, n = 1; aortic homograft, n = 2) from the right ventricle to the right pulmonary artery. Two patients required complete reconstruction of the pulmonary artery confluence using a pulmonary homograft in 1 patient and a hybrid technique of autologous pericardial reconstruction and intraoperative stenting in another patient. All patients had a reduction in right ventricular pressures after operation. One patient died perioperatively owing to respiratory failure; the remaining 4 patients were alive at a median follow-up of 7.4 years (range, 0.5 to 14.7 years). One patient required late balloon dilatation of the conduit and distal pulmonary arteries 10 years after initial operation, but the remaining conduits were widely patent at late follow-up. Late functional improvement was limited owing to other complications from mediastinal fibrosis or other comorbidities. CONCLUSIONS Treatment of pulmonary artery occlusion attributable to mediastinal fibrosis can be challenging. Successful operative strategies include both creation of a double-outlet right ventricle and complete reconstruction of the pulmonary artery confluence. Hybrid techniques of both conduit placement and stenting should also be considered for patients with occluded pulmonary arteries.
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Affiliation(s)
- Morgan L Brown
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Hannan RL, Zabinsky JA, Hernandez A, Zahn EM, Burke RP. Hybrid Treatment of Superior Vena Cava Syndrome in a Child. Ann Thorac Surg 2009; 88:277-8. [DOI: 10.1016/j.athoracsur.2008.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 12/03/2008] [Accepted: 12/09/2008] [Indexed: 10/20/2022]
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46
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Amirghofran AA, Emaminia A, Rayatpisheh S, Malek-Hosseini SA, Attaran Y. Intracardiac Invasive Thymoma Presenting as Superior Vena Cava Syndrome. Ann Thorac Surg 2009; 87:1616-8. [DOI: 10.1016/j.athoracsur.2008.09.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/26/2008] [Accepted: 09/11/2008] [Indexed: 11/27/2022]
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47
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Acute superior vena cava syndrome after insertion of implantable cardioverter defibrillator. J Interv Card Electrophysiol 2008; 23:247-9. [DOI: 10.1007/s10840-008-9295-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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Picquet J, Blin V, Dussaussoy C, Jousset Y, Papon X, Enon B. Surgical reconstruction of the superior vena cava system: indications and results. Surgery 2008; 145:93-9. [PMID: 19081480 DOI: 10.1016/j.surg.2008.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 08/04/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obstruction of the superior vena cava (SVC) secondary to malignant or benign diseases is rarely treated by surgical reconstruction. The purpose of this retrospective study is to report our experience and compare our results with previous data in the literature. METHODS From 1993 to 2006, 24 patients underwent operative reconstruction of the SVC. Mean patient age was 58 years. The underlying disease was primary bronchopulmonary malignant neoplasm in 50%, mediastinal malignant neoplasm in 21%, and symptomatic benign disease in 29%. Forty-six percent of patients presented clinical signs of superior vena cava compression (SVCC). Our indications were based on two criterions: clinical symptoms of superior vena caval compression or histological examination of the superior vena caval lesion that indicates potential for complete surgical excision. RESULTS Median duration of postoperative intensive care was two days. Mortality at 30 days was 12% for malignant diseases. All patients presenting clinical signs of SVCC improved. Mean follow-up was 28 months (range, 1-129). No thrombosis was observed during follow-up. Overall survival was 53% at 1 year and 35% at 5 years. For patients with malignant bronchopulmonary disease, survival was 50% at 1 year and 25% at 5 years. Mortality was 0% for patients with benign disease. CONCLUSION Review of the literature indicates that replacement of the SVC is an uncommon procedure. Our experience suggests that the need for SVC reconstruction should not, however, be considered as a contraindication for resection of a bronchopulmonary or mediastinal neoplasm in an otherwise potentially curable patient, provided it can be achieved in a single block with clear margins. Replacement of the SVC can also be performed with low mortality and morbidity for effective treatment of SVCC secondary to benign disease that fails to respond to medical therapy.
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Affiliation(s)
- Jean Picquet
- Department of Cardiovascular and Thoracic Surgery, University Hospital Center, Angers, France.
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49
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Lénárd L, Szabados S, Imre J, Pintér O, Fazekas A, Tornai Z, Déczy K, Várady E, Papp L. [Vena cava superior syndrome: surgical treatment of the thrombosis of the superior vena cava after implantation of a hemodialysis catheter--a case report and review of the literature]. Orv Hetil 2008; 149:29-34. [PMID: 18089480 DOI: 10.1556/oh.2008.28207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One of the rare reasons of the non malignant superior vena cava syndrome is the thrombosis of superior vena cava. Obstruction or occlusion of central veins is one of the many complications of the more and more frequently used central venous catheters and pacemaker electrodes. The authors report a case of superior vena cava thrombosis resulting in dialysis catheter insufficiency in case of a young, uraemic, female patient wit Tesio catheter and the surgical treatment of it with the use of cardiopulmonary bypass during the operation. Apropos of this case, the authors outline the causes of malignant, non-malignant and iatrogenic superior vena cava syndrome, furthermore the conservative, surgical and catheter therapy of the syndrome.
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Affiliation(s)
- László Lénárd
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar, Szívgyógyászati Klinika, Pécs.
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50
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Rizvi AZ, Kalra M, Bjarnason H, Bower TC, Schleck C, Gloviczki P. Benign superior vena cava syndrome: Stenting is now the first line of treatment. J Vasc Surg 2008; 47:372-80. [DOI: 10.1016/j.jvs.2007.09.071] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/11/2007] [Accepted: 09/23/2007] [Indexed: 10/22/2022]
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