TY - JOUR
T1 - Caval Reconstruction with Undersized Ringed Graft after Resection of Inferior Vena Cava Leiomyosarcoma
AU - Pantoja, Joe L.
AU - Patel, Rhusheet P.
AU - Baril, Donald T.
AU - Quinones-Baldrich, William
AU - Lawrence, Peter F.
AU - Woo, Karen
N1 - Funding Information:
After en bloc resection, IVC reconstruction with undersized ringed PTFE graft is safe. It has acceptable postoperative outcomes including patency with a low complication rate. Graft sizes should be based on the cephalad IVC diameter superior to the tumor. Undersizing the graft by approximately 40% is associated with acceptable patency rates. This generally translates to a 12 mm graft for a 20 mm IVC, 14 mm for a 25 mm IVC, and 16 mm for a 30 mm IVC. Reconstruction of more cephalad segments of IVC requires larger grafts and may present a greater operative challenge. This research was supported by the National Institute of Health ( NIDDK 1K08DK107934 ).
Funding Information:
This research was supported by the National Institute of Health (NIDDK 1K08DK107934).
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/5
Y1 - 2020/5
N2 - Background: The en bloc resection of inferior vena cava (IVC) leiomyosarcoma often necessitates IVC reconstruction. The objective of this study is to examine outcomes after IVC reconstruction and determine optimal graft sizing. Methods: A retrospective review was conducted of all IVC reconstructions after IVC leiomyosarcoma resection at a single institution. Cross-sectional dimensions at the IVC resection margins were measured on preoperative imaging. The tumor location was based on the most superiorly involved region of the IVC and was classified as infrarenal, between hepatic and renal veins, or superior to the hepatic veins. Perioperative details and long-term outcomes including graft sizing, graft patency, morbidity, and mortality were recorded. Results: Between 2007 and 2017, 12 patients (6 females, mean age: 64.5 years, age range: 46–80 years) underwent IVC leiomyosarcoma resection and reconstruction. All reconstructions were performed with ringed polytetrafluoroethylene (PTFE); graft sizes ranged from 12 mm to 16 mm. The tumor location was exclusively infrarenal in seven patients, between the renal and hepatic veins in two patients, and involved multiple segments in three patients. Larger graft sizes were utilized in reconstructing more superior segments of the IVC. Grafts were typically undersized and based on the diameter of the superior resection margin with 12 mm grafts approximately correlating to a 20 mm diameter, 14 mm to 25 mm, and 16 mm to 30 mm. The average undersizing ratio was 0.6. At a mean follow-up time of 43 ± 27 months, radiographic graft patency was 92%, overall survival was 83%, and disease-free survival was 25%. Conclusions: After en bloc resection of IVC leiomyosarcoma, caval reconstruction with an undersized ringed PTFE has acceptable patency. Grafts sizes should be based on the IVC diameter superior to the tumor and undersizing by approximately 40% appears to be associated with acceptable patency rates. Further multiinstitutional studies should be performed to best determine the optimal treatment of this rarely encountered tumor.
AB - Background: The en bloc resection of inferior vena cava (IVC) leiomyosarcoma often necessitates IVC reconstruction. The objective of this study is to examine outcomes after IVC reconstruction and determine optimal graft sizing. Methods: A retrospective review was conducted of all IVC reconstructions after IVC leiomyosarcoma resection at a single institution. Cross-sectional dimensions at the IVC resection margins were measured on preoperative imaging. The tumor location was based on the most superiorly involved region of the IVC and was classified as infrarenal, between hepatic and renal veins, or superior to the hepatic veins. Perioperative details and long-term outcomes including graft sizing, graft patency, morbidity, and mortality were recorded. Results: Between 2007 and 2017, 12 patients (6 females, mean age: 64.5 years, age range: 46–80 years) underwent IVC leiomyosarcoma resection and reconstruction. All reconstructions were performed with ringed polytetrafluoroethylene (PTFE); graft sizes ranged from 12 mm to 16 mm. The tumor location was exclusively infrarenal in seven patients, between the renal and hepatic veins in two patients, and involved multiple segments in three patients. Larger graft sizes were utilized in reconstructing more superior segments of the IVC. Grafts were typically undersized and based on the diameter of the superior resection margin with 12 mm grafts approximately correlating to a 20 mm diameter, 14 mm to 25 mm, and 16 mm to 30 mm. The average undersizing ratio was 0.6. At a mean follow-up time of 43 ± 27 months, radiographic graft patency was 92%, overall survival was 83%, and disease-free survival was 25%. Conclusions: After en bloc resection of IVC leiomyosarcoma, caval reconstruction with an undersized ringed PTFE has acceptable patency. Grafts sizes should be based on the IVC diameter superior to the tumor and undersizing by approximately 40% appears to be associated with acceptable patency rates. Further multiinstitutional studies should be performed to best determine the optimal treatment of this rarely encountered tumor.
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U2 - 10.1016/j.avsg.2019.11.007
DO - 10.1016/j.avsg.2019.11.007
M3 - Article
C2 - 31715248
AN - SCOPUS:85076240696
SN - 0890-5096
VL - 65
SP - 25
EP - 32
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -