Alimi Y S, Gloviczki P, Vrtiska T J, Pairolero P C, Canton L G, Bower T C, Harmsen S, Hallett J W, Cherry K J, Stanson A W
Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minn. 55905, USA.
J Vasc Surg. 1998 Feb;27(2):287-99; 300-1. doi: 10.1016/s0741-5214(98)70359-3.
Superior vena cava (SVC) reconstructions are rarely performed; therefore the need for surveillance and the results of secondary interventions are unknown.
During a 14-year period 19 patients (11 male, 8 female; mean age 41.9 years, range 8 to 69 years) underwent SVC reconstruction for symptomatic nonmalignant disease. Causes included mediastinal fibrosis (n = 12), indwelling foreign bodies (n = 4), idiopathic thrombosis (n = 2), and antithrombin III deficiency (n = 1). Spiral saphenous vein graft (n = 14), polytetrafluoroethylene (n = 4), or human allograft (n = 1) was implanted.
No early death or pulmonary embolism occurred. Four early graft stenoses or thromboses (spiral saphenous vein graft, n = 2, polytetrafluoroethylene, n = 2) required thrombectomy, with success in three. During a mean follow-up of 49.5 months (range, 4.7 to 137 months), 95 imaging studies were performed (average, five per patient; range, one to 10 studies). Venography detected mild or moderate graft stenosis in seven patients; two progressed to severe stenosis. Two additional grafts developed early into severe stenosis. Four of 19 grafts occluded during follow-up (two polytetrafluoroethylene, two spiral saphenous vein graft). Computed tomography failed to identify stenosis in two grafts, magnetic resonance imaging failed to confirm one stenosis and one graft occlusion, and duplex scanning was inconclusive on graft patency in 10 patients. Angioplasty was performed in all four patients with severe stenosis, with simultaneous placement of Wallstents in two. One of the Wallstents occluded at 9 months. Repeat percutaneous transluminal angioplasty was necessary in two patients, with placement of Palmaz stents in one. Only one graft occlusion and one severe graft stenosis occurred beyond 1 year. The primary, primary-assisted, and secondary patency rates were 61%, 78%, and 83% at 1 year and 53%, 70%, and 74% at 5 years, respectively.
Long-term secondary patency rates justify SVC grafting for benign disease. Postoperative surveillance with contrast venography is indicated in the first year to detect graft problems. Endovascular techniques may salvage and improve the patency of SVC grafts.
上腔静脉（SVC）重建术很少进行；因此，监测的必要性以及二次干预的结果尚不清楚。
在14年期间，19例患者（11例男性，8例女性；平均年龄41.9岁，范围8至69岁）因有症状的非恶性疾病接受了SVC重建术。病因包括纵隔纤维化（n = 12）、体内异物（n = 4）、特发性血栓形成（n = 2）和抗凝血酶III缺乏症（n = 1）。植入了螺旋大隐静脉移植物（n = 14）、聚四氟乙烯（n = 4）或同种异体移植物（n = 1）。
未发生早期死亡或肺栓塞。4例早期移植物狭窄或血栓形成（螺旋大隐静脉移植物，n = 2；聚四氟乙烯，n = 2）需要进行血栓切除术，3例成功。在平均49.5个月（范围4.7至137个月）的随访期间，共进行了95次影像学检查（平均每位患者5次；范围1至10次检查）。静脉造影检测到7例患者有轻度或中度移植物狭窄；其中2例进展为重度狭窄。另外2例移植物早期发展为重度狭窄。19例移植物中有4例在随访期间闭塞（2例聚四氟乙烯，2例螺旋大隐静脉移植物）。计算机断层扫描未能识别2例移植物的狭窄，磁共振成像未能确认1例狭窄和1例移植物闭塞，10例患者的双功扫描对移植物通畅情况的判断不明确。4例重度狭窄患者均接受了血管成形术，其中2例同时植入了Wallstent支架。其中1枚Wallstent支架在9个月时闭塞。2例患者需要再次进行经皮腔内血管成形术，其中1例植入了Palmaz支架。1年以上仅发生1例移植物闭塞和1例重度移植物狭窄。1年时的一期、一期辅助和二期通畅率分别为61%、78%和83%，5年时分别为53%、70%和74%。
长期的二期通畅率证明SVC移植治疗良性疾病是合理的。术后第一年建议采用静脉造影进行监测以发现移植物问题。血管内技术可挽救并提高SVC移植物的通畅率。
