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Prosthetic Arterial Bypasses Are Durable In Patients Undergoing Vascular Reconstruction During Lower Extremity Sarcoma Resection
Rahul Gulati, Frank Padberg, Ajay Dhadwal, Timothy Wu, Michael Curi, Joe Huang.
Rutgers - New Jersey Medical School, Newark, NJ, USA.

Objective(s):
Lower extremity sarcomas requiring vascular bypasses at the time of tumor resection are rare events. We evaluate the outcomes of these vascular interventions.
Methods:
A retrospective review conducted at our institution identified all patients from 2008-2014 who underwent significant vascular interventions at the time of lower extremity sarcoma resection. Graft patency, post-operative complications, and overall survival were measured.
Results:
Out of 257 lower extremity sarcoma resections, 13 patients (5.1%) underwent 26 vascular interventions. Median age was 52 years (range, 12-89 years) and 9 (69%) were female. Major vascular interventions included vessel resections without reconstruction of 2 arteries and 14 deep veins. One patient underwent rotationplasty with femoral artery and vein resection, followed by direct reconstruction. Arterial bypasses were performed in 7 patients, with prosthetic conduits used in 5 cases. Muscular flap coverage at the time of vascular intervention was performed in 10 (77%) of patients, including 5 (71%) of the bypass patients. Postoperative wound infections requiring operative debridements occurred in 5 (71%) of the bypass patients. Despite these complications, there were no exposed grafts, no graft infections, and primary arterial graft patency was 100% over a median follow-up period of 34 months (range, 4 to 60 months). Overall survival in this group was 100%.
Conclusions:
Lower extremity sarcomas requiring vascular interventions are rare. Complex vascular interventions may need to be performed in patients with sarcomas involving major vessels. In these situations, prosthetic lower extremity arterial bypasses are durable and effective.

Bypasses performed at time of sarcoma resection
PatientBypassConduitFlap coverageFollow-up (months)Wound infection
1External iliac artery to SFA; femoral vein to external iliac veinPTFERectus abdominis42; 8 daysyes
2CFA to above-knee popliteal arteryPTFETensor fascia lata, rectus abdominis4yes
3SFA to above-knee popliteal arteryPTFEsartorius, adductor34yes
4SFA to above-knee popliteal arteryPTFEgracilis, sartorius6no
5SFA to below-knee popliteal arteryPTFEnone25yes
6SFA to below-knee popliteal arteryFemoral veinsoleus, biceps femoris60no
7Below-knee popliteal to tibial arteryContralateral GSVnone34yes


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