Akademik Veri Yönetim Sistemi
24th Congress of Asian Society for Vascular Surgery, Antalya, Türkiye, 30 Kasım - 03 Aralık 2023, ss.370
INTRODUCTION-PURPOSE
Vena Cava Superior Syndrome (VCSS) is a clinical picture that develops due to partial or complete disruption of normal venous return from the head, upper extremities, thorax and right atrium. It may develop due to infectious diseases, malignancy and thrombosis. In this report, we present a case of VCS revascularization after tumor excision using pericardial roll-patchplasty technique.
CASE REPORT
A 60-year-old woman with a history of known coronary artery disease, tuberculosis lymphadenitis and endometrial ca, presents to the internal medicine outpatient clinic with complaints of facial edema which had been present for about 2 years and increased in the last 2 months. Thoracic computed tomography (CT) of the thorax performed at an external center was evaluated in favor of thrombus in the VCS and anticoagulants were started at a therapeutic dose.
METHODS
VCS tumor excision was performed in a joint operation with the thoracic surgery unit. After excision, it was seen that primary end-to-end repair of the VCS could not be performed due to loss of long segment VCS lumen. VCS revascularization was achieved by roll patchplasty with pericardium(otogreft). The tumor tissue obtained peroperatively was frozen and sent to the pathology unit for detailed study.
RESULTS
Pathology study of the tumor tissue taken from the patient perop is ongoing. VCS vascular structure repaired with pericardial roll-patchplasty showed flow in postop control imaging. The patient did not develop VCSS in postop clinical follow-up.
DISCUSSION
Symptoms may be mild or severe depending on the degree of compression or obstruction. Clinically, cape-like edema of the face and upper extremities, orthopnea, headache may be observed. If it develops due to a malignancy,surgery, chemotherapy, radiotherapy depending on the type of tumor, and endovascular stenting may be performed in some patients who do not respond to treatment or relapse.
CONCLUSIONS
There are many different options for the treatment of VCSS. The most important factor determining the treatment plan is the etiology of the syndrome. In patients in whom surgical treatment is decided, the repair of VCSS should be evaluated in a multidimensional manner and the most appropriate repair method should be decided.