Four cases of obstruction of the superior vena cava caused by inoperable bronchogenic carcinoma are presented in which the signs and symptoms were disabling. Palliation was achieved by placing a 10 mm. Dacron prosthetic bypass graft between the left innominate vein and the right atrial appendage, resulting in prompt relief. All patients were given warfarin for anticoagulation and subsequently deep x-ray therapy and diuretics were added. There was no operative or hospital death or morbidity. Two of the patients died of distant metastases at 14 and 6 months, respectively, postoperatively. The other two are alive and well at 11 and 5 months after the operation. Venous obstruction has not recurred to date in any of the four patients. A relevant review of the literature has been made.