Bypass of superior vena cava: Six years' experience with spiral vein graft for obstruction of superior vena cava due to benign and malignant disease.

Ten patients had operations for obstruction of the superior vena cava (SVC) with SVC syndrome. Four patients had fibrosing mediastinitis and six and had bronchogenic carcinoma. A composite spiral vein graft was placed between the left jugular--subclavian vein and the right atrium to bypass the completely occluded SVC. The graft was constructed from the patient's own saphenous vein, which was split longitudinally and wrapped around a stent in spiral fashion. The edges of the vein were sutured together to form a large autogenous conduit. All patients were immediately relieved of SVC obstructive symptoms and signs. All grafts were patient at 7 days to 18 months, as determined by conventional or radionuclide venography or contrast-enhanced computerized axial tomography. The fact that SVC syndrome has not returned in any patient implies long-term patency. All patients with benign disease continue asymptomatic 3 months to 6 years after operation and have returned to gainful employment. All patients with SVC obstruction resulting from cancer died 1 to 21 months (mean 10.7 months) postoperatively. Spiral vein bypass graft provides effective treatment for SVC obstruction with immediate and long-term relief of SVC syndrome.