Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Reconstruction of the Superior Vena Cava with Extra-luminal Bypass Shunt

우회단락을 사용한 상대정맥증후군의 수술

  • Shin Jae Seung (Department of Thoracic and Cardiovascular surgery, College of Medicine, Korea University) ;
  • Jo Won-Min (Department of Thoracic and Cardiovascular surgery, College of Medicine, Korea University) ;
  • Min Byung Zoo (Department of Thoracic and Cardiovascular surgery, College of Medicine, Korea University) ;
  • Chung Won Jae (Department of Thoracic and Cardiovascular surgery, College of Medicine, Korea University) ;
  • Lee In Sung (Department of Thoracic and Cardiovascular surgery, College of Medicine, Korea University)
  • 신재승 (고려대학교 의과대학 흉부외과학교실) ;
  • 조원민 (고려대학교 의과대학 흉부외과학교실) ;
  • 민병주 (고려대학교 의과대학 흉부외과학교실) ;
  • 정원재 (고려대학교 의과대학 흉부외과학교실) ;
  • 이인성 (고려대학교 의과대학 흉부외과학교실)
  • Published : 2006.01.01
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Abstract

We operated on a 41-year-old man using venous bypass shunt for superior vena cava (SVC) syndrome caused by mediastinal fibrosis. The patient had substantially high venous pressure and high risk of postoperative neurologic deficits. The collateral veins were deemed to be interrupted during the surgical reconstruction of SVC. Treatment included resection of the obstructed SVC and innominate vein and reconstruction with an autologous pericardial tube graft. During the operation, venous drainage from upper body was maintained with an extraluminal bypass shunt. The shunt was effective at prompt relief of venous hypertension, eliminating the time constraints, and preventing the postoperative complications.

종격동 섬유화로 인한 상대정맥증후군을 가진 41세의 남자 환자를 정맥 우회단락을 사용하여 상대정맥 재건술을 시행하였다. 환자는 수술 전 상당히 높은 중심 정맥압을 보였으며, 수술 시 측행혈관이 차단될 수밖에 없어, 수술에 따른 신경학적 합병증의 위험성이 높았다. 수술은 막힌 상대정맥과 무명정맥을 제거한 후에 자가 심낭을 튜브 모양으로 만들어 재건술을 시행하였으며, 수술 중에 정맥 우회 단락을 이용하여 두경부 및 상지의 정맥환류를 유지하였다. 우회단락의 사용은 상대정맥증후군의 수술 시 정맥압을 즉시 감소시키고, 수술시간에 따른 부담이 없었으며, 수술 후 합병증 발생을 예방하는데 효과적이었다.

Keywords

References

  1. Ostler PJ, Clarke DP, Watkinson AF, Gaze MN. Superior vena cava obstruction: a modern management strategy. Clin Oncol (R Coll Radiol) 1997;9:83-9 https://doi.org/10.1016/S0936-6555(05)80445-5
  2. Hwang SH, Kim BJ, Chung SW, Kim JW. Bypass of superior vena cava with spiral vein graft. Korean J Thorac Cardiovasc Surg 1997;30:344-7
  3. Cho YH, Sohn YS, Ryu SM, et al. Surgical treatment of superior vena cava syndrome caused by hemodialysis catheter: report of 2 cases. Korean J Thorac Cardiovasc Surg 2005; 38:67-71
  4. Parish JM, Marschke RF Jr, Dines DE, Lee RE. Etiologic considerations in superior vena cava syndrome. Mayo Clin Proc 1981;56:407-13
  5. Larsson S, Lepore V. Technical options in reconstruction of large mediastinal veins. Surgery 1992;111:311-7
  6. Singh S, Sherif H, Reul GJ. Reconstruction of the superior vena cava with the aid of an extraluminal venovenous jugulo- atrial shunt. Tex Heart Inst J 2000;27:38-42
  7. Alimi YS, Gloviczki P, Vrtiska TJ, et al. Reconstruction of the superior vena cava: benefits of postoperative surveillance and secondary endovascular interventions. J Vasc Surg 1998; 27:287-99; 300-1 https://doi.org/10.1016/S0741-5214(98)70359-3
  8. Dartevelle P, Chapelier A, Navajas M, et al. Replacement of the superior vena cava with polytetrafluoroethylene grafts combined with resection of mediastinal-pulmonary malignant tumors. Report of thirteen cases. J Thorac Cardiovasc Surg 1987;94:361-6