Reconstruction of large veins for nonmalignant venous occlusive disease

Peter Gloviczki, Peter C. Pairolero, Barbara J. Toomey, Thomas C. Bower, Thom W Rooke, Anthony W. Stanson, John W. Hallett, Kenneth J. Cherry

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

To evaluate the effectiveness of venous grafting, we reviewed the management and clinical course of 28 patients (21 males and seven females) who underwent 29 reconstructions of large veins for benign disease. There were 12 patients with superior vena cava (SVC) syndrome, two with subclavian vein thrombosis, and 15 with occlusion of the inferior vena cava (IVC) or iliac veins. One of these patients underwent both IVC and SVC reconstructions. Reconstruction of the SVC was performed with spiral saphenous vein graft (SSVG) in nine patients and expanded polytetrafluoroethylene (ePTFE) in three. All seven straight SSVGs had documented patency at a median of 7 months (2 weeks to 5 years) after reconstruction. Six patients had complete relief of symptoms. Two patients with bifurcated SSVG had early occlusion of one graft limb. Two of the three ePTFE grafts needed early thrombectomy. One graft reoccluded at 6 months and two were patent at 2 and 5 years. The two subclavian vein reconstructions with axillary-jugular ePTFE grafts with an arteriovenous fistula had documented early patency. Both patients had rapid resolution of symptoms. The IVC or iliac vein was reconstructed with ePTFE graft in 11 patients, SSVG in three, and Dacron in one. A femorofemoral arteriovenous fistula was added in eight patients with ePTFE grafts. Seven of the 11 ePTFE grafts had documented patency at the last follow-up (median 9 months; range 2 weeks to 5 years). None of the three SSVGs had documented long-term patency. The one Dacron cavoatrial graft occluded at 3 years. A straight SSVG continues to be our first choice for SVC replacement. Short, large-diameter ePTFE grafts peform the best in the abdomen. Femorocaval or long iliocaval grafts need an arteriovenous fistula to maintain patency. Long-term patency after closure of the fistula is still unknown. Femorocaval grafts with poor venous inflow have limited chance of success. Failed or failing grafts may be salvaged by early thrombectomy. Venous reconstruction to treat selected patients with symptoms with large vein occlusion continues to be a viable option.

Original languageEnglish (US)
Pages (from-to)750-761
Number of pages12
JournalJournal of Vascular Surgery
Volume16
Issue number5
DOIs
StatePublished - 1992

Fingerprint

Veins
Transplants
Polytetrafluoroethylene
Saphenous Vein
Superior Vena Cava
Arteriovenous Fistula
Inferior Vena Cava
Iliac Vein
Subclavian Vein
Thrombectomy
Polyethylene Terephthalates
Superior Vena Cava Syndrome
Abdomen
Fistula
Thrombosis
Neck
Extremities

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Gloviczki, P., Pairolero, P. C., Toomey, B. J., Bower, T. C., Rooke, T. W., Stanson, A. W., ... Cherry, K. J. (1992). Reconstruction of large veins for nonmalignant venous occlusive disease. Journal of Vascular Surgery, 16(5), 750-761. https://doi.org/10.1016/0741-5214(92)90230-6

Reconstruction of large veins for nonmalignant venous occlusive disease. / Gloviczki, Peter; Pairolero, Peter C.; Toomey, Barbara J.; Bower, Thomas C.; Rooke, Thom W; Stanson, Anthony W.; Hallett, John W.; Cherry, Kenneth J.

In: Journal of Vascular Surgery, Vol. 16, No. 5, 1992, p. 750-761.

Research output: Contribution to journalArticle

Gloviczki, P, Pairolero, PC, Toomey, BJ, Bower, TC, Rooke, TW, Stanson, AW, Hallett, JW & Cherry, KJ 1992, 'Reconstruction of large veins for nonmalignant venous occlusive disease', Journal of Vascular Surgery, vol. 16, no. 5, pp. 750-761. https://doi.org/10.1016/0741-5214(92)90230-6
Gloviczki, Peter ; Pairolero, Peter C. ; Toomey, Barbara J. ; Bower, Thomas C. ; Rooke, Thom W ; Stanson, Anthony W. ; Hallett, John W. ; Cherry, Kenneth J. / Reconstruction of large veins for nonmalignant venous occlusive disease. In: Journal of Vascular Surgery. 1992 ; Vol. 16, No. 5. pp. 750-761.
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