Bypassing the obstructed superior vena cava with a subcutaneous long saphenous vein graft

Abstract

A patient with superior vena cava syndrome secondary to a small cell carcinoma of the lung was recently encountered. Diuretic therapy, radiotherapy, and chemotherapy failed to provide relief of symptoms. Consequently, we constructed a bypass graft with a long segment of the left saphenous vein. The vein was drawn through a subcutaneous tunnel over the abdomen and chest to be attached to the left external jugular vein. The resultant decompression of the superior vena cava provided almost immediate relief of symptoms. This simple bypass procedure allows decompression of the superior vena cava with minimal risk of morbidity or death and provides excellent palliation of a most disabling condition.