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Aim, Superior vena cava syndrome is a dramatic event that can be cured in specialized centers.
Methods. Between 1989 and 1995 6 patients with superior vena cava syndrome underwent surgical treatment for thoracic tumors. In all cases the vena was restricted by a neoplastic sleeve. A median sternotomy was performed in all cases. Two patients received an associated right anterolateral thoracotomy to obtain good surgical exposure for tumor resection and grafting. A 12 mm diameter polytetrafluoroethylene graft was inserted in all cases. The tumor resection was radical in 4 cases (2 thymic carcinomas, 2 malignant germ cell tumors) and palliative in 2 (1 non-small cell lung cancer and 1 medias t i nal fibrosis).
Results. We had no in-hospital mortality. all patients had immediate relief of obstruction after by-pass. Three patients were alive without disease at the end of followup (40-96 mo), one patient died of postoperative complications after 4 mo, 2 patients died of disease after 4 and 12 mo.
Conclusion. PTFE by-pass graft for treatment of the obstructed SVC relieves SVC syndrome and has good medium term patency.
KEY WORDS: Superior vena cava syndrome - Surgery - Thorax Neoplasms - Blood vessel prosthesis implantation..
Superior vena cava (SVC) syndrome was first described by William Hunter in 1757 in a patient with syphilitic saccular aortic aneurysm.1 Following Hunter, non-malignant diseases such as thrombophlebitis and mediastinitis due to tuberculosis were the predominant etiologic factors. From the beginning of the 20th century bronchogenic carcinoma and mediastinal tumors have become the most common causes of SVC syndrome.2-4 Doty et al,2 reported that the most common causes of SVC obstruction are lung cancer (85%), metastatic neoplasms (5-10%) and lymphomas (7-20%). Other malignancies less frequently found are thymomas, leiomyosarcomas, carcinoids and germ cell tumors. Primary malignancy of SVC is really rare as is thrombophlebitis.
Benign causes of SVC syndrome are mediastinal inflammations as a result of mediastinitis (5%) and granulomatous disease caused by histoplasmosis infections. Up to now catheter thrombosis of the SVC is becoming increasingly more frequent with the use of new long-term catheterization of jugular or subclavian veins for diagnostic or therapeutic interventions like transvenous pacemaker electrodes, LeVeen shunts and hyperalimentation lines.
By-pass operations, radiation therapy and chemotherapy have been used to treat SVC syndrome....