Abstract
The large size of some retroperitoneal tumors and the complex anatomy of the retroperitoneal structures often require en bloc resection of contiguous organs and, sometimes, resection of critical vascular structures. Vascular reconstructive techniques allow reconstruction of major vascular structures, and autologous vein grafting is the preferred option. Although great saphenous vein can be used in select cases, other options must be explored in cases of caliber mismatch between saphenous vein and native vessel. In addition, the use of synthetic grafts should be avoided in potentially infected vascular beds. The use of the superficial femoral vein in such settings is well documented especially in relation to treatment of infected aortic grafts and has the added advantage of appropriate size match for reconstruction of the major abdominal and pelvic vascular structures. Here, we present a case of a 56-year-old woman with a local recurrence of urothelial cancer in the pelvis after radical cystectomy and radiotherapy. Computed tomography (CT) angiography showed the right iliac artery directly involved by the tumor, and vessel resection was necessary to achieve oncologic surgical margins. The tumor was excised en bloc, and vascular reconstruction using the reversed contralateral superficial femoral vein in an end-to-end fashion was performed. The postoperative course was uneventful. Patient was maintained on low-molecular-weight heparin for 1 month and then on low-dose (100 mg acetylsalicylic acid) antiplatelet therapy and compression stockings. Six months later, the patient is asymptomatic, without leg swelling, and the CT scan shows patency of the vascular repair and no tumor recurrence.
A 56-year-old woman with a local recurrence of urothelial cancer in the pelvis after radical cystectomy and radiotherapy was referred to our institution for evaluation. Computed tomography (CT) angiography showed the right iliac artery directly involved by the tumor, and vessel resection was necessary to achieve oncologic surgical margins. The tumor was excised en bloc (Figure 1). The common and external iliac arteries were clamped and cut 1 cm from the surgical margin after administration of 1 mg/kg heparin and distal ligation of the internal iliac artery (Figure 2). Then, the tumor was resected. Previously, the superficial femoral vein (SFV) was harvested from the contralateral lower limb at an adequate length for reconstruction. Care was taken to preserve the ipsilateral saphenous vein and the profunda femoris vein junction. Vascular reconstruction using the reversed SFV in an end-to-end fashion was performed (Figure 3). The postoperative course was uneventful, and the patient was discharge 13 days later. Patient was maintained on low-molecular-weight heparin for 1 month and then on low-dose (100 mg acetylsalicylic acid [AAS]) antiplatelet therapy and compression stockings. Six months later, the patient is asymptomatic, without leg swelling, and the CT scan shows patency of the vascular repair and no tumor recurrence.
Tumor involving common, internal and external iliac arteries.
Tumor excised in bloc.
Vascular reconstruction with reversed superficial femoral vein in an end-to-end fashion.
Discussion
The large size of some retroperitoneal tumors and the complex anatomy of the retroperitoneal structures often require en bloc resection of contiguous organs and, sometimes, resection of critical vascular structures. Vascular reconstructive techniques allow reconstruction of major vascular structures, and autologous vein grafting is the preferred option. Although great saphenous vein can be used in select cases, other options must be explored in cases of caliber mismatch between saphenous vein and native vessel. In addition, the use of synthetic grafts should be avoided in potentially infected vascular beds. The use of the SFV in such settings is well documented especially in relation to the treatment of infected aortic grafts 1 and has the added advantage of appropriate size match for reconstruction of the major abdominal and pelvic vascular structures. 2
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.