Abstract
Reconstruction of the large vein is more difficult than that of the great artery. Tubular grafts of Gore-tex with pore size of 30-μ have been used in 5 patients for reconstruction of large vein since last two years. Four patients (case I-4) had mediastinal tumor, and the other one (case 5) had the obstruction of the inferior vena cava (IVC) in hepatic region. Malignant thymoma was histologically proved in three cases (case I, 2, 3). Poorly differentiated epidermoid carcinoma was found in one case (case4).
Superior vena cava (SVC) was partially resected and patch angioplasty was done by Gore-tex in easel. SVC was resected and replaced by Gore-tex in case 2. The left innominate vein was resected and the reconstruction was done between the innominate vein and the right atrium (RA) in case 3. In case4, the tumor was unresectable and the bypass grafting was performed between SVC and RA. In case 5 with IVC obstruction, resection was not accomplished, bypass grafting was done between RA and IVC to keep the blood flow of left hepatic vein located just above the site of obstruction.
Mean follow up was 9.5 months in all patients. Except for one case (case 4) with epidermoid carcinoma, four patients (case I, 2, 3, 5) were doing well in post operative course. Venog raphy was performed in 4 patients (case I, 2, 4, 5) after venous reconstruction. Patency of the Gore-tex graft was confirmed in case I and 2 with mediastinal tumors, and in.case 5 with IVC obstruction. Occlusion of the graft was confirmed in case 4.Heparin and Warfarin, as an anticoagulant therapy, were used and thrombotest was maintained in 30-50%. It could be concluded that Gore-tex graft was useful material to make reconstruction of the large vein.
