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Nooromid M, De Martino R, Squizzato F, et al. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. J Vasc Surg Venous Lymphat Disord. 2021;doi: 10.1016/j.jvsv.2021.06.021.
Nooromid, M., De Martino, R., Squizzato, F., Benedetto, F., De Caridi, G., Chou, E. L., Conrad, M. F., Pantoja, J., Abularrage, C., Sorber, R., Garcia-Ortega, D. Y., Luna-Ortiz, K., Eichler, C., Zarkowsky, D., Chia, M., Kalluri, A., Cohnert, T., Szeberin, Z., Grotemeyer, D., Shalhub, S., Fagg, D., Jackson, M. J., Charlton-Ouw, K., Gombert, A., Jacobs, M., Boyd, A., Motaganahalli, R., Uceda, D., Woo, K., Eskandari, M. K. (2021). Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. Journal of vascular surgery. Venous and lymphatic disorders, . https://doi.org/10.1016/j.jvsv.2021.06.021
Nooromid, Michael, et al. "Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience." Journal of vascular surgery. Venous and lymphatic disorders vol. (2021). doi: https://doi.org/10.1016/j.jvsv.2021.06.021
Nooromid M, De Martino R, Squizzato F, Benedetto F, De Caridi G, Chou EL, Conrad MF, Pantoja J, Abularrage C, Sorber R, Garcia-Ortega DY, Luna-Ortiz K, Eichler C, Zarkowsky D, Chia M, Kalluri A, Cohnert T, Szeberin Z, Grotemeyer D, Shalhub S, Fagg D, Jackson MJ, Charlton-Ouw K, Gombert A, Jacobs M, Boyd A, Motaganahalli R, Uceda D, Woo K, Eskandari MK. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. J Vasc Surg Venous Lymphat Disord. 2021 Jul 14; doi: 10.1016/j.jvsv.2021.06.021. Epub 2021 Jul 14. PMID: 34271247.
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J Vasc Surg Venous Lymphat Disord. 2021 Jul 14; doi: 10.1016/j.jvsv.2021.06.021. Epub 2021 Jul 14.

Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience.

Journal of vascular surgery. Venous and lymphatic disorders

Michael Nooromid, Randall De Martino, Francesco Squizzato, Filippo Benedetto, Giovanni De Caridi, Elizabeth L Chou, Mark F Conrad, Joe Pantoja, Christopher Abularrage, Rebecca Sorber, Dorian Yarih Garcia-Ortega, Kuauhyama Luna-Ortiz, Charles Eichler, Devin Zarkowsky, Matthew Chia, Aravind Kalluri, Tina Cohnert, Zoltan Szeberin, Dirk Grotemeyer, Sherene Shalhub, Damen Fagg, Mark J Jackson, Kristofer Charlton-Ouw, Alexander Gombert, Michael Jacobs, April Boyd, Raghu Motaganahalli, Domingo Uceda, Karen Woo, Mark K Eskandari,

Affiliations

  1. Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa.
  2. Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
  3. Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy.
  4. Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
  5. Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif.
  6. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
  7. Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico.
  8. Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif.
  9. Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
  10. Department of Vascular Surgery, Graz Medical University, Graz, Austria.
  11. Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary.
  12. Department of Vascular Surgery, Hopitaux Robert Schuman, Hopital Kirchberg, Luxembourg City, Luxembourg.
  13. Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash.
  14. Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia.
  15. Department of Clinical Sciences, University of Houston College of Medicine and Gulf Coast Vascular, HCA Houston Healthcare, Gulf Coast Division, Houston, Tex.
  16. European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
  17. Division of Vascular Surgery, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
  18. Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind.
  19. Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: [email protected].

PMID: 34271247 DOI: 10.1016/j.jvsv.2021.06.021

Abstract

OBJECTIVE: Primary leiomyosarcoma of the inferior vena cava (IVC) is best managed with surgical resection when technically feasible. However, consensus is lacking regarding the best choice of conduit and reconstruction technique. The aim of the present multicenter study was to perform a comprehensive assessment through the VLFDC (Vascular Low Frequency Disease Consortium) to determine the most effective method for caval reconstruction after resection of primary leiomyosarcoma of the IVC.

METHODS: A multicenter, standardized database review of patients who had undergone surgical resection and reconstruction of the IVC for primary leiomyosarcoma from 2007 to 2017 was performed. The demographics, periprocedural details, and postoperative outcomes were analyzed.

RESULTS: A total of 92 patients (60 women and 32 men), with a mean age of 60.1 years (range, 30-88 years) were treated. Metastatic disease was present in 22%. The tumor location was below the renal veins in 49 (53%), between the renal and hepatic veins in 52 (57%), and above the hepatic veins in 13 patients (14%). The conduits used for reconstruction included ringed polytetrafluoroethylene (PTFE; n = 80), nonringed PTFE (n = 1), Dacron (n = 1), autogenous vein (n = 1), bovine pericardium (n = 4), and cryopreserved tissue (n = 5). Complete R0 resection was accomplished in 73 patients (79%). In-hospital mortality was 2%, with a median length of stay of 8 days. The primary patency of PTFE reconstructed IVCs was 97% and 92% at 1 and 5 years, respectively, compared with 73% at 1 and 5 years for the non-PTFE reconstructed IVCs. The overall 1-, 3-, and 5-year survival for the entire cohort were 94%, 86%, and 65%, respectively CONCLUSIONS: The findings from our multi-institutional study have demonstrated that complete en bloc resection of IVC leiomyosarcoma with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. A ringed PTFE graft was the most commonly used conduit for caval reconstruction, yielding excellent long-term primary patency.

Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Keywords: Inferior Vena Cava; Leiomyosarcoma; PTFE (polytetrafluoroethylene); Vascular Reconstruction; Venous Reconstruction

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