Gloviczki P, Pairolero P C, Cherry K J, Hallett J W
Department of Surgery, Mayo Clinic, Rochester, MN 55905.
J Vasc Surg. 1990 Mar;11(3):373-81. doi: 10.1067/mva.1990.16343.
Encouraged by results from our research laboratory and from recent clinical reports, we performed reconstructions of the vena cava and/or its major tributaries on 16 patients (11 males and five females). Ages ranged from 8 to 81 years (median, 38 years). Eight patients had superior vena cava syndrome (benign, six; malignant, two). Two other patients had membranous occlusion of the inferior vena cava; four had iliocaval venous thrombosis; one had excision of the iliac veins for pelvic neurilemmoma; and one had inferior vena cava injury during orthotopic liver transplantation. The superior vena cava was reconstructed with spiral saphenous vein grafts in five patients and with expanded polytetrafluoroethylene in three. One spiral saphenous vein graft and one expanded polytetrafluoroethylene graft required revision; seven of the eight grafts were patent at follow-up, but one bifurcated spiral saphenous vein graft occluded at 3 months. The inferior vena cava and its tributaries were reconstructed with expanded polytetrafluoroethylene in five patients, spiral saphenous vein graft in two, and Dacron in one. At follow-up four of the expanded polytetrafluoroethylene grafts were patent. In contrast, one of the spiral saphenous vein grafts was occluded, and results of imaging studies of the other were inconclusive. Three of the five expanded polytetrafluoroethylene grafts had a concomitant temporary arteriovenous fistula at the groin; two had documented patency at follow-up. At the present time, spiral saphenous vein graft is our first choice for superior vena cava replacement. However, expanded polytetrafluoroethylene grafts are good alternatives and in the abdomen appear to perform better than spiral saphenous vein graft. These clinical results encourage us to perform further caval grafting in selected patients.
受我们研究实验室的结果以及近期临床报告的鼓舞，我们对16例患者（11例男性和5例女性）进行了腔静脉和/或其主要分支的重建手术。年龄范围为8至81岁（中位数为38岁）。8例患者患有上腔静脉综合征（良性6例，恶性2例）。另外2例患者患有下腔静脉膜性闭塞；4例患有髂股静脉血栓形成；1例因盆腔神经鞘瘤切除髂静脉；1例在原位肝移植期间发生下腔静脉损伤。5例患者用上腔静脉螺旋大隐静脉移植重建，3例用膨体聚四氟乙烯重建。1例螺旋大隐静脉移植和1例膨体聚四氟乙烯移植需要翻修；8例移植中有7例在随访时通畅，但1例分叉螺旋大隐静脉移植在3个月时闭塞。5例患者用膨体聚四氟乙烯重建下腔静脉及其分支，2例用螺旋大隐静脉移植，1例用涤纶。随访时，4例膨体聚四氟乙烯移植通畅。相比之下，1例螺旋大隐静脉移植闭塞，另1例的影像学研究结果不确定。5例膨体聚四氟乙烯移植中有3例在腹股沟处伴有临时动静脉瘘；2例在随访时有通畅记录。目前，螺旋大隐静脉移植是我们进行上腔静脉置换的首选。然而，膨体聚四氟乙烯移植是很好的替代选择，并且在腹部似乎比螺旋大隐静脉移植表现更好。这些临床结果鼓励我们对选定患者进一步进行腔静脉移植。
