胸部静脈再建術が有効であった下行性食道静脈瘤

Reduction of Downhill Esophageal Varices After Intra-thoracic Venous Reconstruction

食道静脈瘤の多くは門脈圧上昇による上行性静脈瘤（UEV）である．下行性静脈瘤（DEV）はまれであり，上大静脈（SVC）閉塞によって上部食道静脈叢からの側副路が発達し，食道上部から瘤が発達していく．

The patient was a 54-year-old male. He underwent invasive seminoma resection, bypass grafting from the left subclavian vein to the right atrial appendage, and patch plasty of the superior vena cava （SVC） 18 years ago in 1990. In 1992, graft obstruction was demonstrated, and in 1994, subsequent downhill esophageal varices developed. Varices deteriorated to grade F3 with a red-colored sign in 2008. Therefore, bypass grafting from bilateral subclavian veins to the right atrial appendage was performed to prevent rupture. Endoscopy performed two weeks after surgery showed that the varices had improved to grade F1. The patient was discharged without adverse events. In 2023, the graft remained patent and the varices did not worsen. After SVC reconstruction, strict follow-up is necessary because fatal event in esophageal varices can occur owing to graft obstruction.