title: Subcutaneous jugulofemoral bypass: a simple surgical option for palliation of superior vena cava obstruction.
abstract: BACKGROUND
  Percutaneous placement of an intraluminal stent is usually a successful intervention for the disabling symptoms of Superior Vena Cava (SVC) obstruction. However, on occasion this may not be feasible and, as malignant disease is responsible for 90% of cases, the morbidity associated with median sternotomy or thoracotomy usually precludes surgical bypass.
  
  
  OBJECTIVE
  To achieve good palliation of the symptoms of SVC obstruction by surgical bypass without performing sternotomy or thoracotomy.
  
  
  METHODS
  Two patients with SVC obstruction secondary to lung cancer and a third after radiochemotherapy for malignant mediastinal teratoma. In all patients intraluminal stenting was considered but was not possible.
  
  
  METHODS
  Jugulofemoral bypass was performed using long saphenous vein which was tunnelled subcutaneously from the femoral to the jugular vein.
  
  
  RESULTS
  One patient required wound exploration for haemorrhage. Good palliation was achieved in all patients. One patient died 3 months post-operatively from lung cancer and the remaining two are alive without symptoms at 13 months and 6 weeks postoperatively.
  
  
  CONCLUSIONS
  Though the majority of patients with SVC obstruction can be treated with non-surgical methods, subcutaneous jugulofemoral bypass may provide good palliation if these are not feasible.
authors.affiliation: Northern Ireland Regional Thoracic Surgery Unit, Royal Victoria Hospital, Belfast, North Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Graham
authors.forename: V
authors.initials: V
authors.lastname: Anikin
authors.forename: R
authors.initials: R
authors.lastname: Curry
authors.forename: J
authors.initials: J
authors.lastname: McGuigan
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D010166:Palliative Care; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000601:surgery*