Objective/backgroundThis study is a case report that addresses the key aspects of vascular reconstruction, as well as the intraoperative complications, postoperative morbidity, and possibility of adjunctive therapy.MethodsThis article reports the case of a 46 year old female patient with a leiomyosarcoma located in the middle segment of the inferior vena cava (between the renal and hepatic veins) who underwent surgical resection with vena cava reconstruction and insertion of a tubular graft made of a synthetic material.ResultsThis case report reveals that surgical resection of the tumor with the insertion of a smaller-caliber tubular graft provide better patency of the vena cava reconstruction, which was maintained for a year after surgery. In addition, the patient was asymptomatic for lower limb edema, despite having a local recurrence after one year. Surgical resection is the treatment of choice for leiomyosarcoma of the inferior vena cava (LIVC) and is the only therapy that offers a chance of cure. Several surgical techniques are used for this condition, especially, reconstruction with a vascular graft using natural or synthetic materials.ConclusionDue to the aggressiveness of the disease, this study suggests that surgical intervention used may have no influence on a patient's survival outcome. However, vascular reconstruction with a smaller-caliber tubular graft may yield a better prognosis for patients in terms of postoperative symptoms, such as edema and thrombosis.
This paper presents a patient successfully treated for leiomyosarcoma of the vena cava, with no recurrence or symptoms on an 8-year follow-up. A 56-year-old woman presented with chronic and progressive periumbilical and right upper abdominal pain. Physical examination and laboratory tests revealed no abnormalities. Computed tomography showed a high-density image inside the vena cava. Cavography showed a filling defect with complete occlusion of the vena cava involving the renal veins and greatly developed collateral circulation through lumbar veins. Laparotomy was performed and a large caval mass involving the renal veins was dissected and resected. Venous reconstruction was undertaken using a 19-mm bovine pericardium prosthesis (Labcor, MG-Brazil) interposed as a substitute to the vena cava, and the renal veins were anastomosed to the side of the graft. Pathologic examination confirmed a leiomyosarcoma with free surgical margins. The postoperative course was uneventful and the patient was discharged on postoperative day 8. The venous flow through the inferior vena became normal, as confirmed by later cavography. This paper presents a case of successfully managed leiomyosarcoma of the vena cava with a thorough review of the literature. The treatment of such patients and the use of bovine pericardium are also discussed.
ResumoOs aneurismas gigantes da artéria basilar constituem um desafio para o neurocirurgião em virtude das limita ções do acesso cirúrgico e da complexidade da patologia. A história natural da doença, no entanto, justifica procedimentos mais agressivos.É relatado um caso de aneurisma gigante no topo da artéria basilar, parcialmente trombosado, operado com parada circulatória e hipotermia. São discutidos os fundamentos da técnica e a indicação.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.