Beating heart superior caval vein replacement for giant venous aneurysm: a case report.

Background: Superior vena cava (SVC) aneurysms are rare vascular anomalies, with <80 cases reported worldwide. Large aneurysms carry a risk of rupture and thrombosis, eventually necessitating surgical intervention.

Case Summary: We present the case of a 68-year-old male with a progressively enlarging SVC aneurysm and a history of paroxysmal atrial fibrillation. The patient underwent successful caval resection and replacement with a 20 mm expanded polytetrafluoroethylene (ePTFE) graft, accompanied by left atrial appendage exclusion and pulmonary vein isolation. The recovery from surgery was uneventful, and postoperative imaging confirmed excellent graft patency with no signs of thrombosis or recurrence at the three-month follow-up.

Discussion: This case highlights the successful management of a large SVC aneurysm through complete resection and prosthetic replacement with a 20 mm ePTFE graft, with the first documented use of this technique in an adult patient. Caval resection and graft replacement ensure complete excision of affected tissue, minimizing the risk of recurrence after surgery for complex SVC aneurysms.