We report a 30-year-old man with superior vena cava syndrome due to fibrosis from a previously irradiated malignant thymoma. The patient presented 4 years after the initial treatment, after having been lost to follow-up. Investigations revealed total obstruction of the superior vena cava, and right subclavian and right internal jugular vein. The patient underwent an extra-anatomic bypass (ringed polytetrafluoroethylene graft 10-mm diameter) between the left internal jugular vein and the left femoral vein brought in a subcutaneous tunnel over the anterior chest and abdominal wall. Entry to the thoracic cavity was avoided due to extensive fibrotic changes visualized in the computed tomographic chest scan. Follow-up Doppler at 2 months, 6 months, 1 year, and 3 years showed a patent graft. An internal jugular vein to the femoral vein bypass is a simple method for palliation of superior vena cava syndrome. © 2006 The Society of Thoracic Surgeons.