Spiral vein graft for obstruction of the superior vena cava: a case report

Catheter-induced superior vena caval thrombosis is a rare complication of the placement of transvenous pacemakers. The authors report such a case in a 44-year-old man. A composite spiral graft of saphenous vein was used to bypass the obstruction. It was anastomosed end to side to the innominate vein and then to the right atrial appendage. The patient improved remarkably immediately after the operation and had an uncomplicated postoperative course. The authors discuss the surgical technique involved and recommend for this rare condition an initial trial of anticoagulant therapy followed by bypass grafting, using the technique they describe, if anticoagulation fails.