Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors.
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.
Shintani
Yasushi
Y
Department of General Thoracic Surgery, E1, Osaka University Graduate School of Medicine, Osaka, Japan.
Ohta
Mitsunori
M
Minami
Masato
M
Shiono
Hiroyuki
H
Hirabayashi
Hirohisa
H
Inoue
Masayoshi
M
Matsumiya
Goro
G
Matsuda
Hikaru
H
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
D003287:Contrast Media; D011138:Polytetrafluoroethylene