Superior Vena Cava Resection
Resection and reconstruction of the superior vena cava (SVC) occasionally is required to surgically treat tumors invading the mediastinum and present a technically challenging situation that may be associated with intra- and postoperative morbidity and mortality. Therefore, careful patient selection and a detailed evaluation of the neoplasm are key to good surgical results. Close cooperation between the anesthetist and surgeon is important because of the need for an adequate surgical procedure as well as continuous intraoperative monitoring of arterial and venous pressure measurements to maintain the physiologic arteriovenous brain parenchymal gradient. A short venous clamping time, implementation of intraoperative pharmacologic agents and fluids, and anticoagulation therapy are technical details that may reduce hemodynamic compromise. SVC reconstruction using either an autologous or a heterologous interposition graft allows the resection of tumors invading the SVC. To better understand the technical difficulties related to this procedure and to avoid major pitfalls, a detailed description of the surgical technique of SVC resection and reconstruction is presented.
KeywordsSuperior Vena Cava Mediastinal Tumor Superior Vena Cava Syndrome Saphenous Vein Bypass Superior Vena Cava Obstruction
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