SUBCUTANEOUS JUGULOFEMORAL BYPASS - A SIMPLE SURGICAL OPTION FOR PALLIATION OF SUPERIOR VENA-CAVA OBSTRUCTION

Background. Percutaneous placement of an intraluminal stent is usually a successful intervention for the disabling symptoms of Superior Vena Cava (SVC) obstruction, However, on occasion this may not be feasible and, as malignant disease is responsible for 90% of cases, the morbid ity associated with median sternotomy or thoracotomy usually precludes surgical bypass. Objective. To achieve good palliation of the symptom s of SVC obstruction by surgical bypass without performing sternotomy or thoracotomy. Patients. Two patients with SVC obstruction secondary to lung cancer and a third after radiochemotherapy for malignant media stinal teratoma, In all patients intraluminal stenting was considered but was not possible. Methods. Jugulofemoral bypass was performed usin g long saphenous vein which was tunnelled subcutaneously from the femo ral to the jugular vein. Results. One patient required wound explorati on for haemorrhage, Good palliation was achieved in all patients, One patient died 3 months post-operatively from lung cancer and the remain ing two are alive without symptoms at 13 months and 6 weeks postoperat ively. Conclusions. Though the majority of patients with SVC obstructi on can be treated with non-surgical methods, subcutaneous jugulofemora l bypass may provide good palliation if these are not feasible.