superior vena cava-right atrium bypass graft

Because the lesions compress the superior vena cava or the innominate vein, the tumor is large and the adhesion to the surrounding tissue is severe and cannot be removed. The bypass graft can be used to relieve the superior vena cava obstruction. Commonly used materials include artificial blood vessels, saphenous veins (sewed spiral blood vessels), superficial femoral veins, umbilical veins treated with glutaraldehyde, and the same aorta. Artificial endothelial cell implantation is still in clinical trials. The two are most commonly used. Artificial blood vessels are easy to use, and polytetrafluoroethylene expanded (PTFE) artificial blood vessels are recommended. The diameter of the selected blood vessels must be large enough (18-20 mm) to improve the long-term patency rate. Using the saphenous vein to open the spiral disk to make the superior vena cava substitute or vascular bridge, the patency rate can be obtained for more than 10 years, but the operation technique is troublesome. Spiral vascular bridge manufacturing method: taking the great saphenous vein with heparin saline to pressurize and smear all the collaterals. Longitudinally breaking the saphenous vein, using a tubular stent with the same diameter as the innominate vein or the internal jugular vein, spirally coiling the dissected saphenous vein along the tubular stent, the intima facing the stent, and ligating the ends The venous edge is sutured continuously with a 7-0 non-invasive slip line. The suture should be uniform, and the outer membrane tissue should not enter the anastomosis margin. Vascular bridge length and diameter design: From the inguinal fossa to the anatomy of the great saphenous vein, the diameter of the great saphenous vein in the middle of the femur was measured as the average diameter. The length of the great saphenous vein is equal to the length of the post-production vessel multiplied by the ratio of the diameter of the vascular bridge to the mean saphenous vein diameter. For example, a spiral saphenous vein bridge with a length of 10 cm and a diameter of 12 mm is required, and a saphenous vein with a length of 30 cm and an average diameter of 4 mm is used (10×12/4=30). In fact, the great saphenous vein from the fossa ovalis to the lap can be made into a vascular bridge with a diameter of 12 mm between the innominate vein and the right atrial appendage. Treatment of diseases: superior vena cava syndrome Indication The superior vena cava-right atrium bypass graft is suitable for patients with close-to-cardiac obstruction of the superior vena cava and patency of the distal end. Due to the short distance of the vascular bridge, the postoperative patency rate is high. It is worth noting that the anastomosis should be made as far as possible from the lesion. Surgical procedure The surgical procedure is basically the same as the anonymous vein-right atrium bypass graft. After cutting the happy bag, the lower part of the superior vena cava and the right atrium can be exposed, and the upper part of the superior vena cava can be explored upwards and taken up at the beginning of the two innominate veins. The upper end of the vascular bridge is anastomosed to the distal end of the superior vena cava, and the lower end is anastomosed to the right atrium.