Surgical reconstruction of the superior vena cava

Abstract

Ten patients (eight men, two women) who underwent surgical reconstruction of the superior vena cava using an expanded polytretrafluoroethylene (ePTFE) prosthesis between 1981 and 1991 were reviewed to assess the therapeutic value of such surgery. The mean (s.d.) age was 55(12) years. Obstruction of the superior vena cava was caused by pulmonary or mediastinal cancer in nine patients and chronic mediastinitis in one. Eight patients had superior vena cava syndrome and two had symptoms of lung disease. The diagnosis of superior vena cava obstruction was made before surgery by computed tomography or superior venacavography in eight patients and during the surgical procedure in two. Tumour resection was performed in five patients. Venous reconstruction was achieved by interposition of an ePTFE graft between the proximal and distal end of the vena cava in three patients and between one (four cases) or two (three cases) tributaries of the superior vena cava and the right atrium in seven. No patient died during the perioperative period. Symptoms of superior vena cava obstruction disappeared promptly after operation in all patients. Postoperative patency was assessed by cavography or computed tomography; all the grafts were patent. During follow-up no patients presented with recurrent superior vena cava syndrome. Eight patients died. The cumulative survival rates were 70, 25 and 12.5% at 1, 2 and 5 years, respectively. Surgical reconstruction of the superior vena cava with an ePTFE prosthesis provided immediate and long-term relief of symptoms of superior vena cava obstruction with a low surgical morbidity, even in patients with unresectable malignancy.