title: Azygous vein to right atrium bypass graft in a patient with idiopathic fibrosing mediastinitis and symptomatic superior and inferior vena cava obstructions.
abstract: We report an unusual case of a patient with diminished cardiac output caused by systemic venous occlusions of unclear etiology with a history of idiopathic fibrosing mediastinitis and retroperitoneal fibrosis. On thoracic, abdominal, and pelvic venograms, the patient was previously known to have superior vena caval and infrarenal inferior vena caval occlusions. Subsequent studies revealed retrograde flow through the azygous and hemiazygous veins and numerous caval-portal anastomoses providing venous return from the upper and lower extremities. After an extensive hypercoagulable state work-up, no abnormalities were found. To relieve the symptoms, the patient underwent an elective right thoracotomy with azygous vein to right atrial bypass graft. The patient has had complete amelioration of the disabling symptoms and participates in many activities that he could not tolerate previously. Because this condition and procedure are unreported, we present a novel surgical treatment option to palliate symptoms caused by concurrent superior and inferior caval obstructions by improving venous return to the heart.
authors.affiliation: Division of Vascular Surgery, University of California-Los Angeles Center for the Health Sciences, 90095, USA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Kakkis
authors.forename: Jason K
authors.initials: JK
authors.lastname: Sicklick
authors.forename: Antoinette
authors.initials: A
authors.lastname: Gomes
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cohen
authors.forename: William J
authors.initials: WJ
authors.lastname: Quiñones-Baldrich
mesh_terms: D000328:Adult; D001401:Azygos Vein / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications*; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000601:surgery; D011138:Polytetrafluoroethylene; D012185:Retroperitoneal Fibrosis / Q000150:complications*; D014682:Vena Cava, Inferior; D014683:Vena Cava, Superior
chemical_list: D011138:Polytetrafluoroethylene