Reconstruction of the vena cava and of its primary tributaries: a preliminary report.

Encouraged by results from our research laboratory and from recent clinical reports, we performed reconstructions of the vena cava and/or its major tributaries on 16 patients (11 males and five females). Ages ranged from 8 to 81 years (median, 38 years). Eight patients had superior vena cava syndrome (benign, six; malignant, two). Two other patients had membranous occlusion of the inferior vena cava; four had iliocaval venous thrombosis; one had excision of the iliac veins for pelvic neurilemmoma; and one had inferior vena cava injury during orthotopic liver transplantation. The superior vena cava was reconstructed with spiral saphenous vein grafts in five patients and with expanded polytetrafluoroethylene in three. One spiral saphenous vein graft and one expanded polytetrafluoroethylene graft required revision; seven of the eight grafts were patent at follow-up, but one bifurcated spiral saphenous vein graft occluded at 3 months. The inferior vena cava and its tributaries were reconstructed with expanded polytetrafluoroethylene in five patients, spiral saphenous vein graft in two, and Dacron in one. At follow-up four of the expanded polytetrafluoroethylene grafts were patent. In contrast, one of the spiral saphenous vein grafts was occluded, and results of imaging studies of the other were inconclusive. Three of the five expanded polytetrafluoroethylene grafts had a concomitant temporary arteriovenous fistula at the groin; two had documented patency at follow-up. At the present time, spiral saphenous vein graft is our first choice for superior vena cava replacement. However, expanded polytetrafluoroethylene grafts are good alternatives and in the abdomen appear to perform better than spiral saphenous vein graft. These clinical results encourage us to perform further caval grafting in selected patients.