[HSF] Occluded SVC

[Nasser F. Abou'Seada]

Dear Hal:
Yes .... and it is marvelous that you realized the event and took care of it
the right way .... many would not notice the cause ...
the point is .... in such case with the pacing wire(S) in the stenosed SVC
.... a deployed stent would be an invitation for a disaster ..!! ....
ascribed to the surgeon at the end !!!! ........
also .... is there any hope of freeing the SVC from the formed thrombus ??
amalgamated with the wires ??? without fragmentation of the thrombus ????
to my mind ........ I'd try a very conservative approach ... a targeted
catheter at the tip of the thrombus ... "now in IJV?" ...... and work it
"down" from there ...........
if failed ... I would not hesitate to do as you have thought ....... a patch
angioplasty ......... a few minutes on bypass would not be a problem .....

leaving it for observation might be ok ....... but as well might be
disasterous ....
a few minutes of bypass ....... with under vision fixation ,..... would not
cause any harm ..

again ....I trust your surgical instincts

NFA
On Jan 31, 2008 5:50 PM, <Hgrmd at aol.com> wrote:

> Nasser,
>  I couldn't tell exactly where the lacerations were located on the  IVC
> and
> SVC.  In both vessels, the bleeding was directly posterior.  I  controlled
> both with horizontal mattress pledgetted 4-0 Prolenes.  Though I  didn't
> realize
> it at the time of surgery, I must have narrowed the SVC with the  repair.
> Inserting the pacing leads a few days later probably occluded the  SVC
> lumen
> sufficiently to precipitate thrombosis.
>
> Hal
>
>
>
> **************Start the year off right.  Easy ways to stay in shape.
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