Leiomyosarcoma of the Inferior Vena Cava: Resection and Vascular Reconstruction Using a Dacron Graft and an Adam De Weese Clip—Three-Year Follow-Up

Vascular Surgery Unit Policlinico Universitario Bari, Bari, Italy.
Annals of Vascular Surgery (Impact Factor: 1.17). 05/2011; 25(4):557.e5-9. DOI: 10.1016/j.avsg.2010.12.015
Source: PubMed


Leiomyosarcomas are rare malignant tumors that particularly affect women. In 2% of all cases, they involve the veins, and in 60% of the cases affecting veins, an involvement of the inferior vena cava (IVC) has been demonstrated. We report a case of IVC leiomyosarcoma operated by resection and reconstruction with a Dacron bypass and apposition of an Adams-DeWeese IVC filter. The latter procedure has never been reported before in association with a graft applied for this disease. Technical and clinical details are described.

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Available from: Domenico Angiletta, Mar 26, 2014
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    • "In contrast, the relatively long left renal vein is well collaterally circulated even in the case of complete IVC obliteration, allowing the preservation of left kidney. However, vascular prosthesis has been recommended to replace the affected renal vessels in aiming to minimize the postoperative occurrence of acute renal failure [11]. "
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    ABSTRACT: Leiomyosarcoma of the inferior vena cava (IVCL) is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins) IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.
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    ABSTRACT: We report the case of delayed reconstruction of an iatrogenically transected inferior vena cava (IVC). A 47-year-old male underwent a laparoscopic right nephrectomy complicated by an unrecognized IVC transection. Postoperatively, he developed severe lower extremity edema, abdominal distension, and discomfort, prompting further investigation. A computed tomography scan showed a staple line extending across the IVC with thrombus extending distally to the level of the left renal vein. Repair of the suprarenal portion of the IVC was undertaken using a cryopreserved femoral vein allograft. The patient demonstrated clinical improvement with follow-up imaging demonstrating graft patency at 15 months.
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    ABSTRACT: Unlabelled: Progredient tumor-growth does not mean necessarily nihilism since (because of the latest multimodal therapeutic options) it might be possible to convert the malignant disease into a chronic stage depending on tumor entity, specific tumor-associated findings and expertise of the interdisciplinary oncological/oncosurgical team to utilize available and potential therapeutic measures. The aim of this report on an unusual case (with its patient-associated, therapeutic and prognostic aspects) of a leiomyosarcoma of the inferior vena cava with advanced tumor growth (characterized initially by pulmonary and hepatic, later on by additional vertebral metastases) is to illustrate its changeful clinical course after and during multimodal treatment episodes comprising surgical (abdomino-/vascular-/cardio- and neurosurgical-locally, R0 resection status), radiological and chemotherapeutic measures. A relatively stable disease over a specific time period of 5 years and 6 months was achieved. The 54-year old female patient with metastasized leiomyosarcoma of the inferior vena cava underwent local tumor resection en bloc with inferior vena cava segmental resection (following vascular surgical interposition of a prosthesis) and hemihepatectomy as well as resection of hepatic segment I. After recovery, a multistep and -modal treatment was initiated comprising of various protocols of systemic chemotherapy, thermoablation of recurrent hepatic metastases, various brachytherapy procedures (for hepatic and pulmonary metastases) and resection of a cerebral metastasis by a neurosurgeon including subsequent radiation. Conclusions: The patient demonstrates impressively that even in case of advanced tumor stage with initial, novel and recurrent metastases, a relatively stable disease over an intermediate time period (of more than 5 years) with an acceptable quality of life was achieved despite several complications.
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