Superior Vena Cava Reconstruction Using An Iliocaval Allograft

Abstract

Successful replacements of the superior vena cava (SVC) using autogenous saphenous or superficial femoral vein or prosthetic grafts have been previously performed, but the use of allograft for treatment of SVC syndrome has not been reported. The patient treated by the authors was a forty-one-year-old woman who presented with severe venous congestion of the head and neck caused by fibrosing mediastinitis. In addition, she had sclerosing cholangitis and chronic liver failure. To treat her SVC syndrome and provide access for fluid and blood transfusion and for possible venovenous bypass, SVC reconstruction was performed concomitant to orthotopic liver transplantation. A left innominate vein-right atrial bypass was inserted using an iliocaval allograft. The patient had an uncomplicated recovery, and at six months after surgery her SVC allograft is widely patent and her transplanted liver is functioning well. The venous allograft is an excellent conduit for those patients who are receiving immunosuppression therapy to avoid rejection of a transplanted organ.

Reconstruction of the superior vena cava: Benefits of postoperative surveillance and secondary endovascular interventions

“…Surgical treatment of SVC syndrome has documented long-term success in both benign and malignant disease. [20][21][22][23][24][25][26][27][28][29][30][31][32] Of the available autologous material, SSVG has been used most frequently for bypass grafting. 20,24,25,28 Advantages of SSVG are that it is autologous material and that graft diameter can be matched to the size of the internal jugular or innominate veins.…”

“…This patient was reported recently. 32 The Kaplan-Meier method was used to calculate primary, primary-assisted, and secondary graft patency rates. 34 All except two patients were receiving oral anticoagulation at discharge.…”

“…Revascularization of the SVC can be achieved by endovascular techniques [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] or by surgical reconstruction. [20][21][22][23][24][25][26][27][28][29][30][31][32] Endovascular techniques such as percutaneous transluminal angioplasty (PTA) and stent placement with or without thrombolysis have been used preferentially for palliation…”

“…7,8,10,11,15,16,19 At our institution surgical treatment has been used since the mid-1980s to treat patients with symptomatic SVC syndrome. 25,28,29,31,32 In some of these patients endovascular techniques have been used as secondary interventions to salvage failing SVC grafts. This report evaluates the late outcome of surgical reconstructions in SVC syndrome caused by benign disease and focuses on the benefits of postoperative surveillance and secondary endovascular interventions in maintaining graft patency.…”