Thrombosis of the Left Brachiocephalic Vein After Subtotal Esophagectomy with Reconstruction Using a Retrosternally Shifted Gastric Tube: Report of a Case

Abstract

We performed a right transthoracic subtotal esophagectomy with systemic three-field lymph node dissection, followed by reconstruction with a gastric tube shifted retrosternally into the left side of the neck, for esophageal cancer in a 62-year-old woman. The patient had an uneventful postoperative course until postoperative day (POD) 9, when a venous thrombosis originating from the left brachiocephalic vein and elongating to the left subclavian vein was detected occasionally on computed tomography scans, although there were no clinical symptoms. The left brachiocephalic vein seemed narrowed by compression from the reconstructed gastric tube, and this was considered the cause of the thrombosis. The patient was commenced on thrombolytic therapy, using urokinase, and on anticoagulation therapy, using heparin and warfarin. The thrombus had disappeared completely by POD 38. The anticoagulation therapy was continued for 6 months and no recurrence of the thrombosis has been detected in the 4 months since its completion.

Retrosternal Reconstruction Can be a Risk Factor for Upper Extremity Deep Vein Thrombosis After Esophagectomy

“…UEDVT after esophagectomy has rarely been reported. Maeda et al reported a case of venous thrombosis in the left brachiocephalic vein after esophagectomy with retrosternal reconstruction using a gastric tube [15]. The authors speculated that the main cause of the thrombosis was compression of the left brachiocephalic vein by the retrosternally shifted gastric tube.…”