Combined open surgical and endovascular management of ruptured femoral artery from recurrent vulvar cancer

Abstract

We report on the case of a 50-year-old woman with exsanguinating haemorrhage from the common femoral artery as a complication of recurrent vulvar cancer in the groin which was managed successfully with combined open surgical and endovascular intervention. She survived another three months and died from progressive disease without further episodes of bleeding. This complication is rare, presents dramatically, and is usually a terminal event. For those cases where intervention is considered appropriate, the option of combined open surgical and endovascular repair should be kept in mind.

Endovascular Management of External Iliac Blowout Syndrome Secondary to Recurrent Sigmoid Cancer

“…3,7,9 Previous reports include endovascular management of peripheral VBOS secondary to scrotal, vulvar cancers, basal cell carcinoma, and retroperitoneal sarcomas. [7][8][9][10] Huntress et al presented successful covered stent revascularization for an impending blowout of the left iliac artery with ipsilateral limb ischemia secondary to retroperitoneal sarcoma. 7 In conclusion, endovascular management of peripheral acute blow out syndrome is a safe and rapid option to control the hemorrhage and restore the arterial integrity in such lifethreatening conditions.…”

“…6,7 Emergent surgery has been described to treat acute VBOS with or without extra-anatomic reconstruction of the affected vascular territory 6 ; however, surgical interference may delay induction of adjunctive or palliative therapy until surgical wound healing is accomplished. Despite having low-risk profile, endovascular therapy is being stated by limited literature as the primary palliative option of VBOS 7 –10 affecting peripheral arteries in comparison to that affecting carotid circulation. We report a case of a recurrent sigmoid colon adenocarcinoma causing acute blowout of the left external iliac artery with subsequent massive bleeding per rectum, and shock.…”

Palliative Endovascular Techniques for Management of Peripheral Vascular Blowout Syndrome in End-Stage Malignancies

“…3 Endovascular techniques have been rarely reported as the primary palliative option in management of VBOS despite a low-risk profile and the precise diagnostic and therapeutic options they provide. [15][16][17] The significantly reduced perioperative morbidity associated with a purely endovascular approach is highly desirable and preferred over complex surgical reconstruction, especially within this frail patient population. Techniques such as superselective tumor embolization and refined stenting techniques via low-profile, balloon-expandable, and self-expanding covered stents offer durable, life-saving A-E, Supraclavicular tumor with threatened blowout of the subclavian artery.…”

Femoral Arterial Blowout Post Groin Recurrence in Vulvar Carcinoma – Novel Endovascular Management

“…There are a few reports on femoral artery blowout in advanced gynaecological and penile cancers. Femoral artery blowout in a case of recurrent vulvar carcinoma is an extremely rare complication and may be due to tumour invasion, lymph node erosion, radiation therapy or tissue necrosis [4]. Femoral arterial rupture is a surgical emergency and if not managed on time can lead to limb ischaemia, exanguinating haemorrhage and death.…”