title: Downhill oesophageal varices resulting from superior vena cava graft occlusion after resection of a thymoma.
abstract: Downhill oesophageal varices (DEV) may occur as a rare complication of superior vena cava (SVC) obstruction. DEV are usually associated with SVC obstruction caused by systemic vasculitis or mediastinal tumours. In this report, we describe a very rare case of DEV resulting from SVC graft occlusion after resection of a thymoma. A 66-year old man with an invasive thymoma was treated by radical resection and bypass grafting from the right brachiocephalic vein to the right atrium. Occlusion of the SVC graft was diagnosed postoperatively; however, the patient could be managed conservatively. Although there had been no significant findings in the oesophagus in previous endoscopic examinations, grade F2 varices were found in the proximal oesophagus in the 19th postoperative month, and DEV caused by SVC graft occlusion was diagnosed. Until now, 2 years since the diagnosis, no apparent symptoms or deterioration of the DEV have been observed. The possible development of DEV should be borne in mind during the follow-up of patients with postoperative SVC graft occlusion.
authors.affiliation: Department of General Thoracic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama-shi, Kanagawa, Japan. yo_inoue@tobu.saiseikai.or.jp
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Inoue
authors.forename: Shoji
authors.initials: S
authors.lastname: Sakai
authors.forename: Teruhiro
authors.initials: T
authors.lastname: Aoki
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology*; D004945:Esophagoscopy; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology*; D013945:Thymoma / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery*
keywords: Downhill oesophageal varices; Vena cava obstruction; Venous graft occlusion