Reconstruction of the superior vena cava: Benefits of postoperative surveillance and secondary endovascular interventions Yves S. Alimi, MD, Peter Gloviczki,

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Presentation transcript:

Reconstruction of the superior vena cava: Benefits of postoperative surveillance and secondary endovascular interventions Yves S. Alimi, MD, Peter Gloviczki, MD, Terri J. Vrtiska, MD, Peter C. Pairolero, MD, Linda G. Canton, RN, BSN, Thomas C. Bower, MD, W.Scott Harmsen, MS, John W. Hallett, MD, Kenneth J. Cherry, MD, Anthony W. Stanson, MD Journal of Vascular Surgery Volume 27, Issue 2, Pages 287-301 (February 1998) DOI: 10.1016/S0741-5214(98)70359-3 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Type I: high-grade superior vena cava stenosis but still normal direction of blood flow through superior vena cava and azygos veins. Increased collateral circulation through hemiazygos and accessory hemiazygos veins. B, Type II: greater than 90% stenosis or occlusion of superior vena cava with normal direction of blood flow through the azygos vein. Journal of Vascular Surgery 1998 27, 287-301DOI: (10.1016/S0741-5214(98)70359-3) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 C, Type III: occlusion of superior vena cava with retrograde flow in both azygos and hemiazygos veins. D, Type IV: extensive occlusion of superior vena cava, innominate and azygos with chest wall and epigastric venous collaterals. Journal of Vascular Surgery 1998 27, 287-301DOI: (10.1016/S0741-5214(98)70359-3) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Postoperative venogram of 43-year-old woman after bifurcated spiral saphenous vein graft implantation reveals bilateral stenosis (arrows) in limbs of bifurcated graft. B, Venogram at 37 months reveals widely patent limbs of bifurcated graft. Lysis of thrombus in graft occurred while patient was receiving oral anticoagulation. C, Percutaneous transluminal angioplasty of stenosis at the atrial anastomosis. D, Venogram confirmed successful angioplasty of anastomotic stenosis with no residual gradient. Journal of Vascular Surgery 1998 27, 287-301DOI: (10.1016/S0741-5214(98)70359-3) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Venogram 6 months after placement of left innominate vein atrial appendage spiral saphenous vein graft in 46-year-old man revealed mild stenosis at proximal anastomosis (arrow indicates stenosis). B, Venogram at 10 months reveals severe stenosis at proximal anastomosis. Note presence of mediastinal collaterals (arrowhead) indicating partial obstruction of flow in graft. C, Venogram 6 months after Wallstent placement confirms widely patent stent and graft. Journal of Vascular Surgery 1998 27, 287-301DOI: (10.1016/S0741-5214(98)70359-3) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A, Venogram at 5 months in 24-year-old man reveals severe stenosis (arrow) in right innominate vein superior vena cava spiral saphenous vein graft. Left innominate vein was reimplanted into saphenous vein graft. B, Venogram after placement of Wallstent (10 × 60 mm) shows good flow through the graft. C, Venogram at 9 months confirms occluded graft and stent. Journal of Vascular Surgery 1998 27, 287-301DOI: (10.1016/S0741-5214(98)70359-3) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Cumulative patency rates of 19 bypass grafts used for superior vena cava reconstruction. Journal of Vascular Surgery 1998 27, 287-301DOI: (10.1016/S0741-5214(98)70359-3) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Cumulative patency rates of 12 straight spiral saphenous vein grafts used for superior vena cava reconstruction. Journal of Vascular Surgery 1998 27, 287-301DOI: (10.1016/S0741-5214(98)70359-3) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions