Stanford W, Doty D B
Ann Thorac Surg. 1986 Feb;41(2):158-63. doi: 10.1016/s0003-4975(10)62659-8.
Venacavography proved to be an excellent guide for the design of patient management programs. Type 1 patients with incomplete obstruction of the superior vena cava (SVC) are best managed by irradiation and chemotherapy regimens and usually do not require operation to bypass the SVC. Types II and IV patients are treated by operation when symptoms of airway obstruction or cerebral venous hypertension are present. Type III patients should be considered for SVC bypass as an initial therapeutic intervention. This group is more likely to have cerebral or airway symptoms and would benefit most from the bypass operation. In terms of operative considerations, type III patients are ideal for operation because the left brachiocephalic vein is usually available for bypass. Type IV patients may also be considered, but operation is more difficult and may require venous thrombectomy or extension of the bypass graft above the thoracic inlet to obtain head and neck decompression.
腔静脉造影被证明是设计患者管理方案的极佳指导。1型上腔静脉（SVC）不完全梗阻患者最好采用放疗和化疗方案进行管理，通常不需要进行手术来绕过SVC。II型和IV型患者在出现气道梗阻或脑静脉高压症状时接受手术治疗。III型患者应考虑将SVC旁路作为初始治疗干预措施。该组患者更可能出现脑部或气道症状，最能从旁路手术中获益。在手术考虑方面，III型患者是理想的手术对象，因为左头臂静脉通常可用于旁路手术。IV型患者也可考虑，但手术难度更大，可能需要进行静脉血栓切除术或将旁路移植物延伸至胸廓入口上方以实现头颈部减压。
