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A 46-year-old woman with stage 5 chronic kidney disease was unable to undergo hemodialysis treatment due to thoracic central venous obstruction (TCVO) and blockage of the tunneled cuffed catheter. This patient also presented with symptoms of TCVO. When percutaneous procedure was not possible, we resolved the obstruction with the innominate-to-right-atrial bypass grafting technique under extracorporeal circulation. There are few reports on this surgical approach. In terms of patient prognosis, this may be an effective solution to this problem. [ABSTRACT FROM AUTHOR]

Objectives: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. Methods: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. Results: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient's symptoms. Conclusion: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy. [ABSTRACT FROM AUTHOR]

Background: Repair of the absence of the whole or major parts of pulmonary arteries is a challenge, and the choice of conduit material to reconstruct the pulmonary arteries is under dispute. We used the autologous innominate vein to construct pulmonary arteries.Case PresentationL: We present a novel technique using the autologous innominate vein as a free graft in a 6-month-old infant with pulmonary atresia and absence of central pulmonary arteries. Double ductus arteriosus were the only source of perfusion of the lungs. The innominate vein was substituted for the central pulmonary artery between the two lung hila. Total repair by using Contegra graft was performed 9 months later. The patient has been followed for 5 years.Conclusions: The autologous innominate vein could be used as inter-hilar pulmonary arteries with no calcification and fibrosis in 5-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Aneurysm of the left brachiocephalic vein is a very rare clinical disease and only 40 cases have been reported so far. Case presentation: The patient was a 61-year-old woman with no related medical history. She underwent CT to investigate the cause of a cough and a mass was noted in the anterior mediastinum. Dynamic computed tomography with contrast medium injected into the left basilic vein demonstrated the venous aneurysm with blood flow to the left brachiocephalic vein. The patient had no symptoms, but because of the risk of pulmonary infarction and aneurysm rupture, the aneurysm was surgically resected. A median sternotomy was a reasonable approach because of the fragility of the venous aneurysm wall with little working space in the anterior mediastinum. Conclusions: We diagnosed an aneurysm of the left brachiocephalic vein on preoperative imaging and excised it through a median sternotomy. The venous wall was thin and fragile in some areas and so this approach was appropriate in view of the possibility of intraoperative injury. [ABSTRACT FROM AUTHOR]

We report a case of vascular injury caused by a multi‐lumen catheter for CRRT inserted through left jugular vein. Diagnosis was delayed because CRRT could be continued. Clinicians should be aware of potential vascular complications associated with the wrong placement of multi‐lumen catheters even if blood flow continues without difficulty. [ABSTRACT FROM AUTHOR]

Thoracic aortocaval fistulae are rare entities where a direct shunt between thoracic arteries and systemic veins is seen. They can be traumatic or congenital in origin. Congenital thoracic aortocaval fistulae usually involve descending aorta and azygos, hemiazygos systems. Presenting symptoms range from continuous murmur to signs of congestive heart failure. In this case report, imaging findings of a 3-year-old girl referred for continuous murmur over the left sternal border are presented. Computed tomography angiography revealed multiple tortuous vessels along the descending aorta with a course toward the left brachiocephalic vein, and was suspicious for an aorta-venous fistula. Subsequent digital subtraction angiography for treatment planning showed a fistula originating at the level of the left 6th intercostal artery, with direct drainage into the left brachiocephalic vein without involvement of the azygos/hemiazygos system. [ABSTRACT FROM AUTHOR]

Background: To compare the efficacy and safety of right internal jugular vein (IJV) approach and right innominate vein (INV) approach for US-guided totally implantable venous access devices (TIVADs), and to explore the advantages and disadvantages of the two approaches.Methods: Six hundred and nineteen adult patients had long-term infusion and chemotherapy needs and inconvenience of peripheral venous infusion. Right INV approach was used to implant 339 cases of TIVADs, and right IJV approach was used to implant 280 cases of TIVADs. The success rate of one-time catheterization and the incidence of complications in the two groups were retrospectively analyzed.Results: All patients were successfully implanted in TIVAD. The success rates of one-time puncture in INV group and IJV approach group were 98.53% (334/339) and 95.36% (267/280), respectively. There was significant difference between the two groups (P = 0.020). The incidence of perioperative complications and long-term complications in the right INV group were 1.18% (4/339) and 3.54% (12/339), respectively, while those in the right IJV group were 1.43% (4280) and 3.93% (11280). There was no significant difference in the incidence of perioperative or long-term complications between the two groups (P = 0.785, P = 0.799, respectively).Conclusions: US-guided TIVADs via the right INV approach and the right IJV approach are both safe and reliable. The right INV approach improves the one-time puncture success rate, as long as the technique is properly operated, serious complications rarely occur. [ABSTRACT FROM AUTHOR]

Aim: Ultrasound guidance has become the routine method for catheterization, dramatically reducing failure and complication rates for totally implantable venous access devices (TIVAD) placement. The aim of the present study was to report the safety and efficacy of ultrasound‐guided right innominate vein TIVAD placement in older patients. Methods: Between September 2015 and September 2017, 55 older patients underwent right innominate vein TIVAD placement under ultrasound guidance. Intraoperative fluoroscopy was always carried out. The technical success rate and complications were recorded and retrospectively analyzed. Results: The technical success rate was 100%. The success rate of the first puncture was 96.36% (53/55). The mean operation time was 28 ± 7 min (range 23–39 min), and the mean length of catheter introduction was 19.24 ± 2.65 cm (range 17–21 cm). The overall incidence of complications was 7.27% (4/55), including one arterial puncture with self‐limiting hematoma, two cases of catheter‐related infection and one case of fibrin sheath. No catheter malposition or catheter fracture was observed. At the time of this study, three TIVAD were pulled out unexpectedly, and 32 TIVAD are still in functional use. Conclusions: Ultrasound‐guided puncture of the right innominate vein is safe and reliable to implant TIVAD, which can provide new options for older patients. Geriatr Gerontol Int 2019; 19: 218–221. [ABSTRACT FROM AUTHOR]

Introduction: Our experience in minimally invasive procedures and improvement of graft technology enables easy and successful operation carried out even with complex thoracic aortic diseases from limited surgical area. However, it should be more than one incision or cannulation site for such intervention. We aimed to present our experience and results of 23 patients who has ascending aorta and aortic arch pathologies of which we operated with J-shaped partial sternotomy and innominate vein cannulation. Methods: From January 2014 to January 2016, 23 patients with aorta and aortic valve pathologies who underwent aortic surgery with J-shaped partial sternotomy and innominate vein cannulation included. Operation findings, cardiopulmonary bypass (CPB) values, postoperative results, surgical mortality and morbidity rates, late conversion to full sternotomy rates, ICU and hospital length of stay were evaluated. Results: The mean age of the patients was 53.7±12 (range 19-68) and 18 (78.2%) were males. Arcus aorta debranching applied to 4 patients (17.3%) and one of these procedures was frozen elephant trunk procedure (4.3%). Neither mortality nor cerebrovascular accident occurred. Mean CPB peak flow was 4.6±0.4 L/min, mean flow index calculated as 2.01±0.38 L/min/m2 and there was no CPB problem intraoperatively. Innominate vein ligation was carried out in 5 patients but no complication was seen except one who had left arm swelling treated with elevation. Conclusion: Innominate vein cannulation with J-shaped partial sternotomy is a reliable and easily applicable method providing effective utilization of limited operative field not only in ascending aorta and aortic arch operations but also with the advancements of hybrid systems used in descending aorta pathologies. [ABSTRACT FROM AUTHOR]

Introduction: Recently, arthroscopy of the sternoclavicular joint (SCJ) has been described in clinical setting. The aim of this study is to examine the accessibility and safety of the SCJ by arthroscopy in a cadaveric model. Materials and methods: An inferolateral and superomedial portal to the SCJ was created in 20 cadaveric specimens. After debridement, the specimens were dissected with a needle positioned in the portal tracts. The distance between the needles and bony landmarks, tendons and ligaments were measured. The integrity of the posterior capsule was evaluated macroscopically. In eight specimens, after anterior dissection, the needles were replaced by K-wires that perforated the posterior capsule to evaluate the distance to the neurovascular structures behind the SCJ. Results: Both portals were found to be safe while allowing good access to the joint. The superomedial portal went through the tendon of the sternocleidomastoideus muscle and the inferolateral portal through the pectoralis major muscle. The portals entered the capsule medial and lateral to the anterior sternoclavicular ligament. The posterior capsule was never perforated during debridement. The perforating K-wires, however, usually perforated either a major vein or artery, but were at a safe distance from the vagal nerve. Conclusions: In this cadaver study, arthroscopy of the sternoclavicular joint could be used as a minimally invasive procedure allowing debridement of the joint without damaging the posterior capsule of the joint. If the capsule is inadvertently be breached, a major risk of neurovascular damage exists. We advise to have a backup of a cardiothoracic surgeon when performing this procedure. [ABSTRACT FROM AUTHOR]

Partial anomalous pulmonary venous connection is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation. The condition is frequently misdiagnosed, and usually identified by transesophageal echocardiography or invasive cardiac catheterization. We present the case of a 26-year-old female with new onset dyspnea on exertion who was diagnosed with the left superior and inferior pulmonary veins draining into the innominate vein via a vertical vein by two and three-dimensional transthoracic echocardiography and multidetector computed tomographic angiography. [ABSTRACT FROM AUTHOR]

Abstract: Innominate vein compression syndrome and May-Thurner syndrome (also called iliac vein compression syndrome) are venous compression syndromes caused by normal anatomic structures. Here, we present a case in which these two conditions were found in the same patient using multidetector row computed tomography. This case is significant for two reasons: (1) it is, to the best of our knowledge, the first case study in the literature to report coexisting innominate vein compression syndrome and May-Thurner syndrome; and (2) it shows that multidetector row computed tomography has powerful diagnostic ability for venous diseases. [Copyright &y& Elsevier]

Mediastinitis is a life-threatening condition and would appear to have been rarely reported as arising as a central-venous catheter-associated complication. Here we report on one cancer patient featuring a Port-A catheter tip positioned within the innominate vein, who developed mediastinitis and mediastinitis-like symptoms subsequent to chemotherapeutic-agent infusion through this catheter. The relevant literature pertaining to this condition was reviewed, and the possible pathophysiology of the condition was discussed. [ABSTRACT FROM AUTHOR]

In a 2002 cadaveric dissection course, a complex manner of rare variation was found in the abnormal venous system of the heart of an 88-year-old Japanese man who died of acute pneumonia. The superior vena cava and the left and right brachiocephalic veins were normal. In this case, a complex venous system existed as follows. (1) A left superior vena cava was persistent. (2) The innominate vein was present. It went upward between the ascending aorta and the pulmonary trunk, passed through the ventral side of the bifurcation of the pulmonary trunk, and then anastomosed with the left superior vena cava. The oblique vein of the left atrium, as a fibrous bundle, was connected to the junction of the left superior vena cava and the innominate vein in the pericardium. (3) The great cardiac vein was divided into two branches. One was located at the right side of the left coronary artery, forming the origin of the innominate vein. The other extended to the coronary sinus as a normal great cardiac vein. (4) The orifice of the coronary sinus on the right atrium was obliterated. (5) The abnormal orifice existed between the left atrium and the coronary sinus. The formation process and functional significance of such venous variations are discussed. [ABSTRACT FROM AUTHOR]

Abstract Transvenous (TV) pacing and defibrillation leads are frequently implanted in children as part of treatment for various congenital and acquired rhythm abnormalities. However, the lead-vascular endothelial interaction is not a benign process and is associated with a risk of progressive venous obstruction. Often, this obstruction requires surgical or interventional relief. The risk of obstruction is related to venous diameters at implant and lead size. Since venous diameters are largely unknown at different ages, the purpose of this study was to correlate innominate vein (iNN) and superior vena cava (SVC) diameters with body dimensions in growing children. [ABSTRACT FROM AUTHOR]

Thrombosis of the brachiocephalic veins or superior vena cava (SVC) is rare. This study was conducted to determine the prevalence and characteristics of thrombosis of brachiocephalic veins and SVC, and its association with symptomatic pulmonary embolism CPE). The prevalence of thrombosis involving the brachiocephalic veins and SVC was evaluated retrospectively at a university hospital during the 3-year period. Patients were identified by hospital records and review of computer-generated lists of of all venograms, contrast-enhanced chest computed tomography, and magnetic resonance angiograms of the upper extremity and SVC. Thrombosis of the brachiocephalic veins and SVC was diagnosed in 33 (0.03 %) of 100,942 patients of all ages [(32 of 70,751 adult patients ≥ 20 years; 0.04%)]. Twenty-three (70%) patients initially had secondary thrombosis with multiple risk factors: associated with malignancy in 14 (42%) patients, chronic disorders in 13 (39%) patients, central venous lines (CVL) and peripheral venous lines (PVL) in 9 (27%) patients, and thrombophilia in 10 (38%) of 26 patients. Swelling of the arm, head, and neck was present in 32 (97%) patients. Symptomatic PE developed before thrombosis being treated in 12 (36%) patients. All patients except eight (three, thrombolytic; five, thrombectomy) received anticoagulant therapy. Thrombosis of the SVC and brachiocephalic veins is an uncommon but serious complication in patients with malignancy, chronic disorders, CVL, PVL, and thrombophilia. Because it is important clinical problem with frequent PE, the patients with appropriate clinical findings should be diagnosed early with imaging tests and treated with anticoagulant drugs. [ABSTRACT FROM AUTHOR]

Objective: A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance.Design: A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position.Setting: We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital.Patients and Participants: The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out.Measurements and Results: The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%.Conclusions: This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised. [ABSTRACT FROM AUTHOR]

This case illustrates a rare finding of flow reversal within the internal jugular vein associated with innominate occlusion and ipsilateral arteriovenous fistula. The patient was an adult male who presented with extreme pain and swelling of the left upper extremity and an ipsilateral nonfunctioning hemodialysis shunt. Doppler waveforms demonstrated turbulence and retrograde flow of the internal jugular vein (IJV). Sonography demonstrated complete occlusion of the left innominate vein. Angiography confirmed the IJV flow reversal and the full extent of the innominate vein clot. Angiography also showed bilateral indwelling innominate stents, as well as visualized the retrograde flow from the IJV crossing left to right via the transfer sinus and descending caudally to the right IJV. As demonstrated in this case, ultrasound works well in tandem with special procedures. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to assess the feasibility of stent dilation of venous obstructions/occlusions to permit transvenous pacing lead implantation. Innominate vein or superior vena cava (SVC) obstruction may preclude the implantation of transvenous pacing leads. Patients with d-transposition of the great arteries, after a Mustard or Senning procedure, and children with previously placed transvenous pacing leads are at higher risk for this vascular complication. From May 1993 to January 1996, eight pediatric patients who underwent transvenous pacing lead implantation or replacement were found to have significant innominate vein or SVC obstruction or occlusion. Utilizing intravascular stents, a combined interventional and electrophysiological approach was used to relieve the venous obstruction and to permit implantation of a new transvenous pacing lead. Two patients had complete SVC occlusion requiring puncture through the obstruction with a transseptal needle. Vessel recanalization was achieved with balloon dilation and stent implantation. The remaining six patients had severe venous obstruction with a mean minimum diameter of 3.1 ± 3.3 mm. The mean pressure gradient across the obstructed veins was 8.6 ± 7.3 mmHg. Following implantation of 15 Palmaz P308 stents in eight vessels, the mean diameter increased to 14.2 ± 1.9 mm and the mean pressure gradient across the stented vessels decreased to 1.0 ± 2.0 mmHg. A transvenous pacing lead was implanted successfully through the stent(s) immediately or 6–8 weeks later. Innominate vein and SVC obstruction can be safely and effectively relieved with intravascular stents and permit immediate or subsequent transvenous pacing lead implantation. [ABSTRACT FROM AUTHOR]

Thrombosis of the innominate vein and SVC is a serious complication in patients with pacemakers, inducing pulmonary embolism or SVC syndrome. Venography is the definitive method for its diagnosis; however, it is too invasive for related studies. The purpose of this study was to validate sonograpby, pulse Doppler, and color flow in detecting noninvasively innominate vein or SVC thrombosis in patients with pacemakers. In 53 patients with pacemakers, the 1 severe SVC stenosis and 18 severe innominate vein stenoses due to thrombosis were diagnosed by digital subtraction angiography. Sonography accurately showed the severe SVC stenosis due to thrombosis, but bad limitations on the innominate vein thrombosis. Color flow demonstrated mosaic flow, indicating poststenotic turbulence due to stenosis of the innominate vein and SVC caused by thrombosis in 15 of 16 patients, and pulse Doppler disclosed absence of flow due to complete occlusion of the innominate vein in 2 of 2 patients. Sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color flow and pulse Doppler was 94% and 100%, respectively. In conclusion, sonography, pulse Doppler, and color flow allow accurate detection of severe innominate vein or SVC stenosis due to thrombosis, and are therefore useful for the follow-up of patients with a pacemaker. [ABSTRACT FROM AUTHOR]

Obstruction of the major venous channels from the upper body is rarely due to benign disorders. We report a 53-year-old man with a ten year history of sarcoidosis who developed acute symptomatic left innominate vein obstruction and massive left-sided pleural effusions. Left neck exploration revealed obstruction of the innominate vein and thoracic duct by the matted sarcoid lymph nodes. Symptoms of left innominate vein obstruction and the massive effusion subsided shortly after lymphadenectomy. In view of the frequency of sarcoid cervical lymphadenopathy, this disease should be considered in the differential diagnosis of benign causes of symptomatic obstruction of the venous drainage of the upper part of the body. [ABSTRACT FROM AUTHOR]

Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3–0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF—27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible. [ABSTRACT FROM AUTHOR]

Injuries to the branches of the aortic arch are rare and may be caused by blunt, penetrating, blast or iatrogenic trauma. Innominate vascular injury is a rare entity, particularly in blunt trauma. It is estimated that 71% of patients with innominate injuries die before arrival at the hospital. We report here a successfully managed case of a combined blunt trauma of the innominate artery and transection of the left innominate vein after blunt injury to the chest. [ABSTRACT FROM AUTHOR]

A case of chylothorax following innominate vein thrombosis which developed as a late complication of transvenous pacemaker implantation is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be a chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. Aetiological work-up showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge, this is the first report of a case of this nature. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: To evaluate the feasibility and safety of ultrasound-guided totally implantable venous access port (TIVAP) implantation via the right innominate vein in patients with breast cancer. Methods: Sixty-seven breast cancer patients underwent ultrasound-guided implantation of TIVAPs via the right innominate vein for administration of chemotherapy. Clinical data including technical success, success rate for the first attempt, periprocedural, and postoperative complications were recorded and retrospectively studied. Results: All patients underwent successful surgery. The success rate of the first attempt was 95.52% (64/67). The operation time was 28 to 45 min, with an average of 36 ± 6 min. Periprocedural complications included artery punctures in 1 (1.50%, 1/67) patient. Prior to this study, the mean TIVAP time was 257 ± 3 days (range 41 to 705 days). The rate of postoperative complications was 4.48% (3/67), including catheter-related infections in 1 case and fibrin sheath formation in 2 cases. Up to the present study, three people had unplanned port withdrawal due to complications, and the TIVAPs for 25 patients were still in normal use. Conclusions: The success rate of ultrasound-guided TIVAPs via the right innominate vein is high with low complications, thus safe and feasible. This technique can provide a new option for chemotherapy of breast cancer patients. [ABSTRACT FROM AUTHOR]

A case of chylothorax following innominate vein thrombosis, which developed as a late complication of transvenous pacemaker implantation, is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. The aetiological workup showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge this is the first report of a case of this nature. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Congenital aneurysms of the thoracic venous system are rare. In particular, innominate venous aneurysms are extremely rare. We describe a 16-year-old girl whose chest x-ray suggested a mediastinal tumor. Three-dimensional contrast-enhancement magnetic resonance venography showed a giant sacciform aneurysm of the left innominate vein and dilatation of the right innominate vein. The patient was asymptomatic, and there were no significant physical findings. Therefore, the patient is being followed without surgical treatment. [ABSTRACT FROM AUTHOR]

An unique case of left innominate vein compression by a leftward origin of a brachiocephalic artery in conjunction with an aberrant right subclavian artery anomaly occurred in a young patient. Aortography and magnetic resonance imaging were invaluable in arriving at a diagnosis. [ABSTRACT FROM AUTHOR]

The article describes a rare case of displacement of the left brachiocephalic vein in a 51-year-old man who underwent surgery for right upper lobe lung cancer. The displacement was revealed by three-dimensional computed tomography results. Upper mediastinal lymph node dissection could not be performed to treat the patient.

Purpose: To report the endovascular reconstruction of the superior vena cava (SVC), innominate and internal jugular veins following stenosis due to mediastinal fibrosis. Case Report: A 36-year-old female with mediastinal fibrosis was referred for symptomatic SVC syndrome (SVCS). A covered stent was inserted in the SVC with 2 kissing stents in the innominate and jugular veins via anterograde right femoral vein access with sandwich technique. She exhibited near-immediate relief of debilitating symptoms. Computed tomographic scan demonstrated patent vessels at 1 year. Conclusions: Extensive endovascular venous reconstruction is an effective treatment for SVCS due to mediastinal fibrosis. [ABSTRACT FROM AUTHOR]

Disruption of the innominate vein during cardiac surgery is an uncommon emergency, is life threatening, and may result in an extreme severity of superior vena cava syndrome. The innominate vein at the superior vena cava junction was injured, requiring surgical occlusion. As bailout procedure to avoid superior vena cava syndrome, a venous bypass between the innominate vein and the right atrium was constructed. Subsequent three-graft coronary bypass was performed. This conduit was patent at 48 h and four postoperative weeks. The patient did not develop superior vena cava syndrome. [ABSTRACT FROM AUTHOR]

Aneurysms of the innominate vein are extremely rare. Fifteen such cases have been reported in literature. They may be asymptomatic or may present as a mediastinal mass with compression of adjacent structures or may present with vascular complications like thromboembolism or rupture. We present a case of large innominate vein aneurysm presenting as a mediastinal mass that was surgically excised through a left thoracotomy without use of cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]