Abstract
We report a case of obstruction of the superior vena cava caused by lung cancer. After chemo-radiotherapy, we performed right pneumonectomy and resected the superior vena cava (SVC). It was possible to perform complete resection of the carcinoma, and a 10-mm diameter polytetrafluoroethylene graft was inserted, end-to-end, between the azygos vein and the right appendage, because the bilateral innominate veins were obstructed by thrombus. It took about 11 hours after starting operation to reconstruct the bypass, and during the course of the operation, the symptoms of SVC syndrome grew worse. Immediately after the operation, it was impossible to remove the tracheal tube because of edema of the vocal cords. The next day the symptoms rapidly improved and on the fourth postoperative day, the tracheal tube was extubated. The patient has survived for 31 months since the operation and has no clinical findings of SVC syndrome. We conclude that in surgical cases with obstruction of the SVC caused by lung cancer, preoperative collateral venous flow is decreased by the skin incision, lymph node dissection, and other operative procedures, so that : 1. even if the SVC is totally obstructed, the time between the start of the operation and reconstruction of the SVC bypass should not be long, and 2. to our knowledge, azygos vein- right appendage internal bypass has not been reported previously, but in view of the patient's subsequent clinical course, this bypass appeared to be effective.
