Vascular Reconstruction for Limb Salvage in Sarcoma of the Lower Extremity

Koperna, Thomas; Teleky, B.; Vogl, Sonja; Windhager, Reinhard; Kainberger, Franz; Schatz, Klaus-Dieter; Kotz, R.; Polterauer, P

doi:10.1001/archsurg.1996.01430220097023

Cited by 51 publications

(54 citation statements)

References 22 publications

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“…Generally, venous reconstruction had not been considered to be beneficial for this edema because of early clotting [1,6]. Despite the frequent occlusion of venous grafts, venous reconstruction may still prevent massive edema because of the rapid development of collateral venous circulation [3,4,16]. Indication for venous reconstruction may also be based on the presence or absence of other routes of venous outflow [2,3,17], particularly deep veins.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, patients with soft tissue sarcomas involving vessels have been successfully managed by limb salvage surgery consisting of wide en bloc resection of the tumor along with the vessels and reconstruction of the segmental vascular defect with synthetic or autogenous saphenous vein grafts [1][2][3][4]. Resected arteries are always reconstructed in order to preserve viability of the limb, but venous reconstruction is not considered to be essential for limb salvage [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Revascularization after segmental resection of lower extremity soft tissue sarcomas

Adelani

Holt

Dittus

et al. 2007

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Revascularization after segmental resection of lower extremity soft tissue sarcomas

Adelani

Holt

Dittus

et al. 2007

Journal of Surgical Oncology

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“…Both autologous vein and prosthetic material have been used successfully (Table 1). Some authors have preferred the use of autologous material in preference to prosthetic graft [5,22,29] . The great saphenous vein remains a common and popular choice of graft for both arterial and venous reconstructions.…”

Section: General Principles Of Surgical Techniquementioning

confidence: 99%

“…Imparato et al [23] 3 Saphenous Nambisan et al [35] 6 PTFE 33% Steed et al [36] 1 Saphenous Karakousis et al [37] 9 PTFE 0% Kawai et al [26] 7 PTFE (5), saphenous (2) 14% Koperna et al [29] 13…”

Section: Number (N ) Graft Materials (N ) Patencymentioning

confidence: 99%

Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts

McGoldrick¹,

Butler²,

Lavelle³

et al. 2016

WJO

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Soft tissue sarcoma accounts for approximately 1% of all cancers diagnosed annually in the United States. When these rare malignant mesodermal tumours arise in the pelvis and extremities, they may potentially encase or invade large calibre vascular structures. This presents a major challenge in terms of safe excision while also leaving acceptable surgical margins. In recent times, the trend has been towards limb salvage with vascular reconstruction in preference to amputation. Newer orthopaedic and vascular reconstructive techniques including both synthetic and autogenous graft reconstruction have made complex limb-salvage surgery feasible. Despite this, limb-salvage surgery with concomitant vascular reconstruction remains associated with higher rates of post-operative complications including infection and amputation. In this review we describe the initial presentation and investigation of patients presenting with soft tissue sarcomas in the pelvis and extremities, which involve vascular structures. We further discuss the key surgical reconstructive principles and techniques available for the management of these complex tumours, drawn from our institution's experience as a national tertiary referral sarcoma service.

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“…Reports of complications in this group include pseudoaneurysm and prolonged distal ischemia eventually requiring vascular reconstruction [3]. Reported complications in the anastomosis group include thrombosis at the anastomosis, requiring vascular revision [9,11,17,20,21,27,32]. Currently, there is no consensus regarding whether one of the approaches results in a higher rate of complications.…”

Section: Introductionmentioning

confidence: 99%

Vascular Management in Rotationplasty

Mahoney

Hartman

Simon

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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The Van Nes rotationplasty is a useful limbpreserving procedure for skeletally immature patients with distal femoral or proximal tibial malignancy. The vascular supply to the lower limb either must be maintained and rotated or transected and reanastomosed. We asked whether there would be any difference in the ankle brachial index or complication rate for the two methods of vascular management. Vessels were resected with the tumor in seven patients and preserved and rotated in nine patients. One amputation occurred in the group in which the vessels were preserved. Four patients died secondary to metastatic disease diagnosed preoperatively. The most recent ankle brachial indices were 0.96 and 0.82 for the posterior tibial and dorsalis pedis arteries, respectively, in the reconstructed group. The ankle brachial indices were 0.98 and 0.96 for the posterior tibial and dorsalis pedis arteries, respectively, in the rotated group. Outcomes appear similar using both methods of vascular management and one should not hesitate to perform an en bloc resection when there is a question of vascular involvement. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Vascular Reconstruction for Limb Salvage in Sarcoma of the Lower Extremity

Cited by 51 publications

References 22 publications

Revascularization after segmental resection of lower extremity soft tissue sarcomas

Revascularization after segmental resection of lower extremity soft tissue sarcomas

Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts

Vascular Management in Rotationplasty

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