No abstract

No abstract

Based on two patients suffering from chronic visceral ischemia, the anatomic and pathophysiologic principles prior to surgery are discussed. Antegrade revascularization is supposed to be better hemodynamically. Complete revascularization of multiple arteries seems to be theoretically superior to one-vessel procedures. Within the bypass procedures the aortic-celiac-mesenteric patch bypass could be an excellent surgical possibility combining antegrade with simultaneous revascularization of celiac and superior mesenteric artery.

If the clinical course of SVCS represents an absolute emergency, irradiation may have to be started immediately, even before the histologic diagnosis is established. Alternatively, expandable metallic stents have been used with considerable success for treatment of vena caval obstruction since patients respond immediately after stent implantation. For diagnosis, a chest X-ray and a CT scan should be performed. Chemotherapy is the treatment of choice for high-grade lymphomas, germ cell tumors and small-cell lung cancer since this modality is more effective than radiotherapy (response rate: 80%). For less chemotherapy responsive tumors radiotherapy is the primary treatment. Successful experience with thrombolytic agents is limited to treatment of catheter-induced SVCS, in contrast, only 20% of patients respond to thrombolytic therapy in the absence of a central catheter. Surgical resection of SVCS associated tumors has not improved survival rates and should be avoided.

No abstract