184 WHICH ROUTE FOR ESOPHAGEAL RECONSTRUCTION WHEN NONE IS FEASIBLE?

Which route for esophageal reconstruction when none is feasible? Methods What is in the video: this 3-minute video describes a challenging case of a complex esophageal reconstruction for a giant trachea-esophageal fistula in a patient with severe comorbidities and a radiation-induced mediastinal fibrosis. We depict the technical aspect of a presternal gastric by-pass covering with a pediculized myocutaneous latissimus dorsi flap. Results Why this video is important for the congress: this video exposes the surgical dilemma of the route of reconstruction for digestive continuity when none of traditional routes are allowed: 1) posterior mediastinum route forbidden because of post-radiation mediastinal fibrosis; 2) retrosternal route prohibited by a previous coronary artery by-pass; 3) subcutaneous route not feasible because of severe sternal radiodermatis. Conclusion In conclusion, our case shows that covering the presternal digestive interposition with a locoregional pediculized myocutaneous flap is a valid alternative when others routes have been eliminated. Video https://drive.google.com/open?id=1SXueOktZU15N8GgG324KJJb1SF-XqPym

Kissing Stents for Superior Vena Cava Syndrome Due to Mediastinal Fibrosis

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.