Superior vena cava syndrome: Relief with a modified saphenojugular bypass graft

Superior vena cava (SVC) syndrome is a disabling and potentially life-threa tening complication. SVC revascularization can be achieved by means of endo vascular or direct surgical reconstructions. In the patient on whom we repo rt, these two options were not possible, and a peripheral venous bypass gra fting procedure was done with a technical innovation. Right upper-extremity swelling developed in a 55-year-old woman after radiation therapy for lung carcinoma. A left subclavian vein Port-A-Cath induced extensive thrombosis of the left innominate, axillosubclavian, and jugular veins. She was refer red to our institution with very symptomatic SVC syndrome after two failed endovascular interventions. The occlusion of both innominate veins and chro nic thrombus extending into the left axillosubclavian and internal jugular veins was confirmed by means of a venogram. A third endovascular attempt fa iled. The presternal skin had severe radiation-induced damage precluding di rect SVC reconstruction. A bypass grafting procedure from the right interna l jugular to the femoral vein was performed with spliced bilateral greater saphenous veins tunneled inside an externally supported expanded polytetraf luoroethylene graft. Postoperatively, the patient had no symptoms, and graf t patency was confirmed by means of duplex ultrasound scanning. A saphenoju gular bypass grafting procedure ran offer prompt and durable relief of SVC syndrome when endovascular or direct surgical reconstructions are not possi ble. This rarely used peripheral venous bypass grafting procedure was modif ied by tunneling the vein graft inside an externally supported poly tetrafl uoroethylene graft to prevent kinking or compression.