Outcomes of Vascular Resection and Reconstruction in Extremity Soft Tissue Sarcoma and Bone Tumors

Shah, AnChetan; Ramanujan, Vishnu; Muralidharan, Krishna; Raja, Anand

doi:10.5758/vsi.200064

Cited by 8 publications

(3 citation statements)

References 19 publications

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“…Despite reports of various graft patency rates in previous studies, the results have generally been better in arterial reconstruction than venous reconstruction. 15,16 Shah et al 15 calculated patency according to conduit type in their recent study and found that synthetic grafts seemed to produce poorer patency rates in veins (20%) than in arteries (71.4%). Mlees et al 17 reported a result similar to ours for arterial patency according to conduit and found that arterial graft occlusion rate was not significantly greater in the synthetic graft group than in the autologous vein group.…”

Section: Discussionmentioning

confidence: 99%

Venous Reconstruction in Extremity Soft Tissue Sarcoma Is Not Essential

Kang

Choi

Han

et al. 2023

Vasc Endovascular Surg

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Objective Limb salvage is an important concern following complete oncologic resection for extremity soft tissue sarcoma (STS). Vascular reconstruction is essential for limb salvage. The purpose of this study was to evaluate the outcomes of vascular reconstruction in patients with extremity STS. Methods This is a retrospective, multi-center, case series of consecutive patients who underwent vascular reconstruction during extremity STS resection at 2 major centers in Korea. Demographics, reconstruction methods, type of conduit, surgical complications, graft patency, limb salvage rate, and patient survival were reviewed. Results From March 2005 to December 2020, 43 patients underwent vascular reconstructions during STS resection. Among the patients, 22 (51.2%) received arterial only, and 21 (48.8%) received simultaneous arterial and venous reconstructions. For the types of conduits, autologous saphenous veins (56.2%), artificial grafts (26.3%), and cryopreserved allografts (15.8%) were used. During a median follow-up of 23.8 months (interquartile range; 7.7-54.5), the overall primary patency of the reconstructed vessels was significantly higher in arteries than in veins (82.5% vs 56.3% at 12 months, P < .001). According to the type of conduit, the primary patency rate of autogenous vein seemed higher in venous reconstruction, however, there was no statistical significance in both arterial and venous reconstruction. There was no significant difference in primary arterial patency rate ( P = .132) or incidence of surgical complications including postoperative edema or wound problem whether or not simultaneous venous reconstruction was performed with arterial reconstruction. The overall limb salvage rate and patient survival were 97.4%, 95.1%, and 89.4% and 91.9%, 81.7%, and 65.4% at 12, 24, and 36 months, respectively. Conclusions Patency rates were poorer in venous reconstruction than in arterial reconstruction. In terms of arterial patency and postoperative complication, the role of simultaneous arterial and venous reconstruction seems not essential, however, it needs to be evaluated in future studies.

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Section: Discussionmentioning

confidence: 99%

Venous Reconstruction in Extremity Soft Tissue Sarcoma Is Not Essential

Kang

Choi

Han

et al. 2023

Vasc Endovascular Surg

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“…Reconstruction options include the use of synthetic or biological grafts. Biological grafts have been reported to have a lower thrombotic rate [ 7 , 16 ]. In our case, the tumor partially encased the popliteal vessels, and we performed en-bloc resection with popliteal vessels and reconstruction with saphenous vein.…”

Section: Discussionmentioning

confidence: 99%

“…Follow-ups were conducted as per protocol [ 7 ], every month for 1 year, every 3 months for the next 2 years, every 6 months for the subsequent 2 years, and annually thereafter. Routine examination was performed using handheld Doppler, and duplex ultrasound (DUS) was performed if the findings were suggestive of graft occlusion.…”

Section: Casementioning

confidence: 99%

Limb Salvage Surgery in a Rare Case of Recurrent Parosteal Osteosarcoma with Vascular Graft Thrombosis

Kumar,

Krishnan,

Muralidharan

et al. 2023

Vasc Specialist Int

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Recurrent parosteal sarcomas with vascular involvement are rare and present unique challenges in their diagnosis and management. We report the case of a 21-year-old woman with parosteal osteosarcoma of the left distal femur, encasing the popliteal vessels. En bloc transarticular resection of the distal femur and popliteal vessels was performed, followed by reconstruction using a modular prosthesis and a saphenous vein autograft for both the artery and vein. On the 1st postoperative day, the patient developed an arterial thrombus requiring reintervention with a jump polytetrafluoroethylene (PTFE) graft. Histopathology confirmed parosteal osteosarcoma. After a disease-free survival of 41 months, the patient experienced local recurrence involving the PTFE graft, leading to graft compression, erosion, and subsequent thrombosis. Despite these complications, limb salvage was possible due to adequate collateral blood supply. This case highlights the feasibility of limb salvage surgery in select cases of parosteal osteosarcoma with vascular involvement.

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