Reconstruction of the superior vena cava by biologic conduit: assessment of long-term patency by magnetic resonance imaging

Superior vena cava graft infection in thoracic surgery: a retrospective study of the French EPITHOR database

 

OBJECTIVES

To report our experience on the management of superior vena cava graft infection.

METHODS

Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected.

RESULTS

Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%.

CONCLUSIONS

Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi).

Superior Vena Cava Resection and Reconstruction with Resection of Primary Lung Cancer and Mediastinal Tumor

The superior vena cava is a short ∼7-cm valveless vessel that brings blood from the upper half of the body to the heart but has connections to the infracardiac venous structures as well. It can become obstructed, mostly by advanced lung cancer but benign conditions account for one-fourth of cases. When possible, reconstruction can be by biological material or via ring reinforced grafts. When perfomed, replacement should be with small caliber grafts to allow for rapid flow of blood, which, with the addition of anticoagulants, reduces the risk of thrombosis. Even with advanced malignancy, treatment may confer reasonable survival.

Autogenous pericardial angioplasty for thymic malignancies: a narrative review

Locally advanced thymic tumor usually invades adjacent great vessels, while the optimal treatment strategy for vessels resection and prosthetic replacement is still in controversial. We hereby present our series of patients undergoing autologous pericardial angioplasty for thymic malignancies. For invasive thymic tumors involving the superior vena cava (SVC), the replacement vessel was prepared by autologous pericardium and placed between the right atrium and distal left innominate vein stump to establish a SVC bypass. Then, the distal right innominate vein and proximal SVC were blocked, and the thymic tumor and involved vessel were completely resected, followed by SVC reconstruction using pericardium. We retrospectively analyzed the clinical characteristics and short-term outcomes of six related patients with autologous pericardial angioplasty. Due to the homologous advantages of autologous pericardial transplantation, those patients didn't need to receive anticoagulant therapy during the perioperative period, so as to avoid the occurrence of hemorrhage, embolism and other graft-related complications. There were no postoperative long-term thoracic drainage (>7 days), anastomotic bleeding, reconstructed vascular stenosis, embolism or even secondary thoracotomy and other related complications occurred in this case series. The application of autologous pericardium for the replacement of mediastinal great vessels in the surgery of locally advanced thymoma is a safe and effective technique. Compared with former artificial materials, such as polytetrafluoroethylene synthetic prosthesis, autologous pericardial transplantation avoids the occurrence of high risk graft-related complications such as postoperative hemorrhage and vascular stenosis, and its clinical application prospect is worth expecting.

Hemodialysis Catheter Tip Design: Observations on Fluid Flow and Recirculation

Purpose

To observe fluid flow patterns and measure recirculation rates of tunneled hemodialysis catheters using a mechanical model that simulates hemodialysis treatment.

Materials and methods

Nine tunneled hemodialysis catheters were evaluated using a mechanical model that simulated catheter conditions during a routine hemodialysis treatment. Objective and subjective determinants of catheter performance were measured and compared. Catheters were evaluated with blood lines connected in standard and reversed configurations using a fluid flow rate of 425 ml/min.

Results

With blood lines in standard configuration the Split Cath® was the only catheter to exhibit an atypical fluid flow pattern and significant tip movement. When the blood lines were reversed, three split-tip catheters had significant tip movement. The three step-tip catheters and two symmetric tip catheters had stable fluid flow patterns and no significant tip movement with blood lines connected in standard and reverse configurations. The nine catheters had no recirculation when connected in standard configuration. When the blood lines were reversed the percentage of recirculating fluid for symmetric tip, step-tip, and split-tip catheters was 0%, 15% to 20%, and 20% to 30%, respectively. The Equistream®, Palindrome™, and Symetrex catheters had no recirculation with blood lines connected in standard or reversed configurations.

Conclusions

Eight of the nine catheters evaluated in this study performed well with blood lines connected in standard configuration. When blood lines were reversed, symmetric tip and step-tip designs had more stable fluid flow patterns, less tip movement and lower recirculation rates when compared to split-tip designs.