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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2003 Ottobre;44(5):667-71

lingua: Inglese

The difficult approach to neoplastic superior vena cava syndrome: surgical option

Lequaglie C., Conti B., Brega-Massone P. P., Giudice G.

Divi­sion of Tho­racic Sur­gery Isti­tuto Nazi­o­nale ­Tumori, ­Milan, ­Italy

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Aim. ­Superior ­vena ­cava syn­drome is a dra­matic ­event ­that can be ­cured in spe­cial­ized cen­ters.
­Methods. ­Between 1989 and 1995 6 ­patients ­with ­superior ­vena ­cava syn­drome under­went sur­gical treat­ment for tho­racic ­tumors. In all ­cases the ­vena was ­restricted by a neo­plastic ­sleeve. A ­median ster­notomy was per­formed in all ­cases. Two ­patients ­received an asso­ciated ­right ante­ro­lat­eral thor­a­cotomy to ­obtain ­good sur­gical expo­sure for ­tumor resec­tion and ­grafting. A 12 mm diam­eter poly­tet­ra­flu­o­roe­thy­lene ­graft was ­inserted in all ­cases. The ­tumor resec­tion was rad­ical in 4 ­cases (2 ­thymic car­ci­nomas, 2 malig­nant ­germ ­cell ­tumors) and pal­li­a­tive in 2 (1 non-­small ­cell ­lung ­cancer and 1 med­i­as­tinal ­fibrosis).
­Results. We had no in-hos­pital mor­tality. All ­patients had imme­diate ­relief of obstruc­tion ­after by-­pass. ­Three ­patients ­were ­alive ­without dis­ease at the end of ­follow-up (40-96 mo), one ­patient ­died of post­op­er­a­tive com­pli­ca­tions ­after 4 mo, 2 ­patients ­died of dis­ease ­after 4 and 12 mo.
Con­clu­sion. ­PTFE by-­pass ­graft for treat­ment of the ­obstructed SVC ­relieves SVC syn­drome and has ­good ­medium ­term ­patency.

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