Doty J R, Flores J H, Doty D B
Department of Surgery, LDS Hospital, Salt Lake City, Utah, USA.
Ann Thorac Surg. 1999 Apr;67(4):1111-6. doi: 10.1016/s0003-4975(99)00145-9.
Previous midterm experience with the composite spiral saphenous vein graft to bypass the obstructed superior vena cava (SVC) has been favorable. This study looks at the long-term results in patients followed for up to 23 years.
Sixteen patients aged 17 to 68 years had operation for obstruction of the SVC with SVC syndrome caused by benign disease. Eleven patients had fibrosing mediastinitis with or without caseous necrosis, 4 had thrombosis caused by a catheter or a pacemaker electrode, and 1 had spontaneous thrombosis. All operations were performed using a composite spiral vein graft constructed from the patient's own saphenous vein. Graft diameter ranged from 9.5 to 15.0 mm. Ten grafts were from the left innominate vein, and six grafts were from the right or left internal jugular vein. The grafts were placed to the right atrial appendage in all patients except 1. Follow-up extends from 1 month to 23 years 8 months (mean follow-up, 10.9 years).
Fourteen of 16 grafts remain patent for up to 23 years, and all patients but 1 are free from SVC syndrome. One patient required revision of the graft for thrombosis 4 days after operation. Two grafts closed during the first year after operation: one because of recurrence of spontaneous venous thrombosis and the other because of aggressive fibrosing mediastinitis requiring operation for graft revision three times over a 12-year period prior to death.
These data demonstrate that a spiral vein bypass graft for treatment of the obstructed SVC relieves SVC syndrome and has excellent long-term patency.
既往使用复合螺旋大隐静脉移植物旁路移植治疗上腔静脉（SVC）梗阻的中期经验效果良好。本研究观察了随访长达23年的患者的长期结果。
16例年龄在17至68岁的患者因良性疾病导致SVC梗阻并伴有SVC综合征而接受手术。11例患者患有纤维性纵隔炎，伴有或不伴有干酪样坏死，4例因导管或起搏器电极导致血栓形成，1例为自发性血栓形成。所有手术均使用由患者自身大隐静脉构建的复合螺旋静脉移植物进行。移植物直径为9.5至15.0毫米。10个移植物取自左无名静脉，6个移植物取自右或左颈内静脉。除1例患者外，所有患者的移植物均置于右心耳。随访时间从1个月至23年8个月（平均随访时间为10.9年）。
16个移植物中有14个在长达23年的时间里保持通畅，除1例患者外，所有患者均无SVC综合征。1例患者术后4天因血栓形成需要对移植物进行翻修。2个移植物在术后第一年闭塞：1个是因为自发性静脉血栓复发，另1个是因为侵袭性纤维性纵隔炎，在死亡前的12年里需要进行3次移植物翻修手术。
这些数据表明，用于治疗梗阻性SVC的螺旋静脉旁路移植物可缓解SVC综合征，并具有出色的长期通畅率。
