Idiopathic mediastinal fibrosis is a rare disease of unknown aetiology. It is a benign condition in which abnormal proliferation of fibrous tissue occurs within the mediastinum, leading to constriction and obliteration of local structures, particularly the great veins. It is a rare cause of superior vena caval obstruction (1-2%) but one that is potentially amenable to surgical palliation. The results of venous reconstruction in five patients with superior vena caval obstruction secondary to idiopathic mediastinal fibrosis are reported. Reversed autogenous saphenous vein grafts were used in two patients, woven silicone rubber prostheses in two, and bovine pericardial conduits in one patient. Useful long term results were obtained in three patients, but the bovine pericardial graft and one of the vein grafts failed within a few weeks.
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