HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shintani, Y. Articles by Matsuda, H. Search for Related Content PubMed PubMed Citation Articles by Shintani, Y. Articles by Matsuda, H. Related Collections Mediastinum Great vessels

J Thorac Cardiovasc Surg 2005;129:809-812
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors

Department of General Thoracic Surgery, E1, Osaka University Graduate School of Medicine, Osaka, Japan

Received for publication February 25, 2004; revisions received April 20, 2004; accepted for publication May 4, 2004.

^_* Address for reprints: Mitsunori Ohta, MD, Department of General Thoracic Surgery, E1, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. (E-mail: ohta{at}surg1.med.osaka-u.ac.jp).

OBJECTIVE: We sought to investigate the correlation between type of vascular reconstruction and long-term graft patency after replacement of brachiocephalic veins combined with resection of mediastinal malignancies.

METHODS: Eighteen patients underwent surgical resection of tumors and the superior vena cava with concomitant vascular reconstruction using ringed polytetrafluoroethylene grafts. Graft patency was verified by means of venography or contrast-enhanced computed tomography at time points ranging from 3 to 77 months (median, 33 months) postoperatively.

RESULTS: Seven patients underwent sole reconstruction of the right brachiocephalic vein, with occlusion observed in only 1 patient. In 6 patients who underwent reconstruction of the bilateral brachiocephalic veins with 2 separate grafts, the grafts remained patent in 2, whereas 4 patients experienced occlusion of one of the two grafts yet remained asymptomatic. Both patients who underwent reconstruction with a Y graft experienced left brachiocephalic vein graft occlusion. In the 3 patients who underwent reconstruction of a left brachiocephalic vein, the graft became occluded, and superior vena cava syndrome developed in 2 of these patients.

CONCLUSION: When replacing the superior vena cava, reconstruction of a left brachiocephalic vein alone results in a significant rate of occlusion and development of superior vena cava syndrome. Thus we advocate sole right brachiocephalic vein reconstruction or bilateral brachiocephalic vein reconstruction in this setting, and separate reconstruction of the veins is preferable to use of a Y graft.

This article has been cited by other articles:

				A. Gomez-Caro, E. Martinez, A. Rodriguez, D. Sanchez, J. Martorell, J. M. Gimferrer, A. Haverich, W. Harringer, J. L. Pomar, and P. Macchiarini Cryopreserved Arterial Allograft Reconstruction After Excision of Thoracic Malignancies. Ann. Thorac. Surg., December 1, 2008; 86(6): 1753 - 1761. [Abstract] [Full Text] [PDF]

				G. Xu, C. Alexiou, M. Tofeig, and T. J. Spyt Management of superior vena cava obstruction syndrome due to thrombosis of a Contegra conduit used to re-establish the innominate vein-to-right atrium continuity Interactive CardioVascular and Thoracic Surgery, August 1, 2007; 6(4): 517 - 518. [Abstract] [Full Text] [PDF]

				L. Spaggiari, F. Leo, G. Veronesi, P. Solli, D. Galetta, B. Tatani, F. Petrella, and D. Radice Superior Vena Cava Resection for Lung and Mediastinal Malignancies: A Single-Center Experience With 70 Cases Ann. Thorac. Surg., January 1, 2007; 83(1): 223 - 230. [Abstract] [Full Text] [PDF]

				V. L. Vida and A. R. Castaneda Reply to talwar et Al. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 414 - 414. [Full Text] [PDF]

				V. L. Vida, J. Leon-Wyss, F. Garcia, and A. R. Castaneda A Gore-Tex 'new-innominate' vein: a surgical option for complicated bilateral cavopulmonary shunts Eur. J. Cardiothorac. Surg., January 1, 2006; 29(1): 112 - 113. [Abstract] [Full Text] [PDF]