title: Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Thoracic Surgery, E1, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shintani
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Ohta
authors.forename: Masato
authors.initials: M
authors.lastname: Minami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shiono
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Hirabayashi
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Inoue
authors.forename: Goro
authors.initials: G
authors.lastname: Matsumiya
authors.forename: Hikaru
authors.initials: H
authors.lastname: Matsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D016121:Brachiocephalic Veins / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D008875:Middle Aged; D010690:Phlebography; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D011474:Prosthesis Design; D013479:Superior Vena Cava Syndrome / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency / Q000502:physiology*; D014683:Vena Cava, Superior / Q000601:surgery
chemical_list: D003287:Contrast Media; D011138:Polytetrafluoroethylene