Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease

A, Venogram 10 months after placement of left innominate vein to right atrial appendage spiral saphenous vein graft in a 46-year-old man with mediastinal fibrosis shows severe stenosis (arrow) at the proximal anastomosis. B, Venogram 6 months after Wallstent (arrow) placement confirms widely patent stent and graft. C, Venogram of right to left internal jugular crossover graft (arrow) performed 16 months later because of persistent right arm and neck swelling. D, Early occlusion of crossover graft at 2 months. E, Venogram 6 months after placement of right innominate vein to right atrial appendage spiral saphenous vein graft shows external compression of the distal graft (arrow). F, Venogram obtained after Wallstent (arrow) placement. Both grafts remain patent 4 years later.

A, Cumulative primary, assisted primary, and secondary graft patency after open surgical bypass in 29 patients. SEM < 10% for all time points. B, Cumulative secondary patency after placement of 23 vein grafts and 6 expanded polytetrafluoroethylene (ePTFE) bypass grafts to treat superior vena cava obstruction. Dotted line represents SEM > 10%.

A, Cumulative primary, assisted primary, and secondary graft patency after open surgical bypass in 29 patients. SEM < 10% for all time points. B, Cumulative secondary patency after placement of 23 vein grafts and 6 expanded polytetrafluoroethylene (ePTFE) bypass grafts to treat superior vena cava obstruction. Dotted line represents SEM > 10%.

A, Venogram shows type II superior vena cava obstruction (arrow) due to mediastinal fibrosis in a 38-year-old man. Successful placement of a Palmaz stent resulted in immediate resolution of symptoms. B, Venogram 14 months after stent palcement shows high-grade stenosis of the left innominate vein proximal to the stent. This was successfully treated with balloon angioplasty. C, Venogram 8 months later shows recurrence of stenosis (arrow). D, Venogram after balloon angioplasty to treat stenosis of left innominate vein and stent shows widely patent stent. Patient has undergone two additional balloon angioplasty procedures over 10 months to maintain patency.

Clinical outcome scores at last follow-up in 32 patients with superior vena cava syndrome due to nonmalignant disease. Twenty-nine patients underwent open surgical treatment; 3 patients underwent primary endovascular treatment.