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Image of Vascular Surgery

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Image of Vascular Surgery

Vasc Specialist Int 2021; 37(1): 58-59

Published online March 31, 2021 https://doi.org/10.5758/vsi.210017

Copyright © The Korean Society for Vascular Surgery.

Oncovascular Resection and Reconstruction of Recurrent Retroperitoneal Liposarcoma Adherent to the Iliac Veins and Vena Cava

Nikolaos Kontopodis1 , Eelco de Bree2, Demosthenis Michelakis2, and Christos V. Ioannou1

1Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, 2Department of Surgical Oncology, University of Crete Medical School, Heraklion, Greece

Correspondence to:Nikolaos Kontopodis, Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, PO-Box 1352, Heraklion 71110, Greece
Tel: 30-2810-392-393, Fax: 30-2810-375-365, E-mail: kontopodisn@yahoo.gr, https://orcid.org/0000-0002-6792-5003

Received: February 27, 2021; Revised: March 4, 2021; Accepted: March 9, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

A 62-year-old patient presented with a 5-cm local recurrence of a retroperitoneal myxoid liposarcoma invading the right common iliac vein (CIV) and the distal segment of the inferior vena cava (IVC) (Fig. 1). Imaging studies were negative for other local recurrences or metastatic diseases. Intraoperatively, it became apparent that venous resection would be required to achieve complete excision with negative margins since the tumor adhered to the CIV and IVC (Fig. 2). Therefore, the patient underwent removal of both CIVs and infrarenal IVC and reconstruction with a 16-8-mm bifurcated Dacron graft (Fig. 3). The left limb of the synthetic graft was placed anterior to the artery to reduce the risk of graft occlusion due to external pressure from the overlying artery. An arteriovenous fistula has been suggested to increase graft patency; however, in the case of a bifurcated graft, two distal fistulas would be needed. Therefore, we opted for life-long therapeutic anticoagulation instead (Xarelto; Bayer, Leverkusen, Germany). The postoperative course was uneventful, and no morbidity of the venous circulation in either leg was observed. The patient was discharged on the 11th postoperative day.

Figure 1. Computed tomography scan showed a recurrent tumor involving the right common iliac vein (RCIV) and distal vena cava. IVC, inferior vena cava.

Figure 2. Intraoperative photograph showed the neoplastic mass involving the right common iliac vein (RCIV) and extending to the confluence and distal vena cava. IVC, inferior vena cava; RCIA, right common iliac artery.

Figure 3. After curative resection, vein reconstruction was performed using a bifurcated graft. Note that the left limb has been positioned anterior to the right common iliac artery (RCIA) to avoid external compression. IVC, inferior vena cava.

Retroperitoneal sarcomas often recur locally. In the absence of systemic disease, resection is the treatment of choice which often results in prolonged disease control, when the approach is optimized. Vascular involvement may necessitate vessel resection and planned reconstruction, as part of the curative resection [1]. Vascular surgeons are increasingly involved in oncologic surgeries, and according to the concept of oncovascular surgery, tumor excision with concomitant resection of the involved vessels may be curative and margin-free [2]. Since oncovascular surgeries may represent a minority of oncologic surgeons’ routines, the potential role of vascular surgeons during these complex procedures may not be appreciated. Therefore, it has been suggested that unplanned intraoperative consultations, especially for caval injuries, present significantly inferior outcomes to those of the planned multidisciplinary approach [3,4]. In this regard, the CIV and IVC can be safely resected if needed and reconstructed with a standard bifurcated graft [5].

Fig 1.

Figure 1.Computed tomography scan showed a recurrent tumor involving the right common iliac vein (RCIV) and distal vena cava. IVC, inferior vena cava.
Vascular Specialist International 2021; 37: 58-59https://doi.org/10.5758/vsi.210017

Fig 2.

Figure 2.Intraoperative photograph showed the neoplastic mass involving the right common iliac vein (RCIV) and extending to the confluence and distal vena cava. IVC, inferior vena cava; RCIA, right common iliac artery.
Vascular Specialist International 2021; 37: 58-59https://doi.org/10.5758/vsi.210017

Fig 3.

Figure 3.After curative resection, vein reconstruction was performed using a bifurcated graft. Note that the left limb has been positioned anterior to the right common iliac artery (RCIA) to avoid external compression. IVC, inferior vena cava.
Vascular Specialist International 2021; 37: 58-59https://doi.org/10.5758/vsi.210017

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