title: [Reconstruction of the superior vena cava by artificial graft bypass between right brachiocephalic vein and right atrial appendage preserving azygos vein circulation for mediastinal non-seminomatous germ cell tumor].
abstract: A 24-year-old man was admitted to our hospital for surgical resection of mediastinal non-seminomatous germ cell tumor after 4 courses of BEP therapy (cisplatin, bleomycin, etoposide). Although it became markedly smaller after chemotherapy, the tumor invaded the superior vena cava (SVC) and the left brachiocephalic vein (LBCV). Venogram demonstrated SVC obstruction above the azygos vein and missing LBCV. A blood return from the left upper limb was shown through thoracodorsal vein, intercostal vein, and accessory hemi-azygos continuation. Excision of residual tumor with SVC and LBCV was done through a median sternotomy. Vascular reconstruction was performed between the right brachiocephalic vein and the right atrial appendage with ringed polytetrafluoroethylene graft. SVC was sutured just above the azygos vein to preserve collateral circulation. LBCV reconstruction was abandoned because distal end of LBCV was entirely surrounded by postchemotherapy scar tissue. Venous occlusive symptoms were not seen in both intraoperative and postoperative period.
authors.affiliation: Department of Thoracic Surgery, Iwate Prefectural Central Hospital, Morioka, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Ishida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oura
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Niikawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Handa
authors.forename: Masafumi
authors.initials: M
authors.lastname: Mitsui
mesh_terms: D020517:Atrial Appendage / Q000601:surgery*; D001401:Azygos Vein; D016121:Brachiocephalic Veins / Q000601:surgery*; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D013479:Superior Vena Cava Syndrome / Q000601:surgery*; D013736:Testicular Neoplasms; D014656:Vascular Surgical Procedures / Q000379:methods; D014683:Vena Cava, Superior / Q000601:surgery*; D055815:Young Adult