Temporary extracorporeal jugulosaphenous bypass for the peri-operative management of patients with superior vena caval obstruction: a report of three cases.

Abstract

Superior vena caval obstruction from a mediastinal mass presents a significant risk to patients requiring general anaesthesia, with reports of sudden death on induction of anaesthesia, during intubation and on initiation of positive pressure ventilation. We describe the first reported use of temporary extracorporeal jugulosaphenous bypass in three cases of superior vena caval obstruction and extrinsic tracheal compression caused by massive retrosternal multinodular goitre. The bypass was performed before induction of general anaesthesia with consequent reduction in upper body venous pressure and avoidance of complications.