Following resection of a leiomyosarcoma, the superior vena cava (SVC) was successfully replaced by means of a spiral graft constructed from autogenous saphenous vein. This technique has previously been applied only as a bypass operation in patients with total occlusion of the SVC causing SVC syndrome. Our patient had mild SVC obstruction and absence of venous hypertension in the upper body before the operation in which segmental SVC replacement was employed. She has remained free from signs or symptoms of SVC obstruction, and graft patency was demonstrated ten months after operation. The literature concerning use of the spiral graft is reviewed, and our operative technique is described. Use of a spiral vein graft should be considered whenever large veins must be replaced.