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Ann Thorac Surg 1973;15:483-492
© 1973 The Society of Thoracic Surgeons

Articles

Superior Vena Caval Obstruction Secondary to Fibrosing Mediastinitis

Robert E. Miller, Col, MC, USA*, Francis J. Sullivan, Ph.D.

From the Department of Surgery and Clinical Research Service, Fitzsimons General Hospital, and Physiology Division, U.S. Army Medical Research and Nutrition Laboratory, Denver, Colo
We are grateful to Gary L. Neal, Maj, George F. Schuchmann, Lt Col, and Robert L. Treasure, Lt Col, all MC, USA, for their assistance in the management of Patient 8, and to Jerome H. Kaplan, Maj, MC, USA, for the angiographic support

Accepted for publication December 4, 1972.

* Address reprint requests to Dr. Miller, Longmont Clinic, 1925 Mountain View Ave., Longmont, Colo. 80501


   Abstract
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 Abstract
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Eight patients with obstruction of the superior vena cava (SVC) secondary to fibrosing mediastinitis are presented. Four patients were managed without surgical reconstruction of the SVC. Of these, 2 are severely symptomatic from SVC obstruction, I is asymptomatic, and I is alive though his condition is unknown.

Four patients were managed with surgical replacement of the SVC. Each is asymptomatic. One of 2 aortic homografts is occluded and the other is markedly stenosed at the cephalad suture line. A late occlusion occurred in the Teflon prosthesis. In the fourth patient, a bypass graft using composite autogenous veins was complemented with an arteriovenous fistula. Venography in this patient at one, six, and thirteen months revealed graft patency; he has no limitations in his physical activities.


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  1. Barrett NR. Idiopathic mediastinal fibrosis Br. J. Surg. 1958;46:207.[Medline]
  2. Benvenuto R, Rodman FSB, Gilmour J, Phillips AF, Callaghan JC. Composite venous graft for replacement of the superior vena cava Arch. Surg. 1962;84:570.[Medline]
  3. Boruchow IB, Johnson J. Obstructions of the vena cava Surg. Gynecol. Obstet. 1972;134:115.[Medline]
  4. Effler DB, Groves LK. Superior vena caval obstruction J. Thorac. Cardiovasc. Surg. 1962;43:574.
  5. Hewlett TH, Steer A, Thomas DE. Progressive fibrosing mediastinitis Ann. Thorac. Surg. 1966;2:345.[Free Full Text]
  6. Miller DB, Allen ST, Amidon EL. Obstruction of the superior vena cava presumably due to histoplasmosis Am. Rev. Tuberc. 1958;77:848.[Medline]
  7. Miller, R. E., Corneil, N. J., and Sullivan, F. J. Replacement of superior vena cava with autogenous tissue: An experimental study. Ann. Thorac. Surg. P. 474, this issue.
  8. Rheinlander HF. Superior vena cava replacement: Report of a successful autogenous composite vein graft J. Thorac. Cardiovasc. Surg. 1969;57:774.[Medline]
  9. Salyer JM, Harrison HN, Winn Jr. DF, Taylor RR. Chronic fibrous mediastinitis and superior vena caval obstruction due to histoplasmosis Dis. Chest 1959;35:364.[Medline]
  10. Sisler GE, Tice DA. Radical right pneumonectomy using preserved allograft vein for caval replacement Ann. Thorac. Surg. 1972;14:299.[Abstract/Free Full Text]



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This Article
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