Leiomyosarcoma of the Inferior Vena Cava- Our Approach
Sashi K. Inkollu, M.B, B.S, Mahesh Ramchandani, MD, Michael Reardon, MD, Alan Lumsden, MD.
Houston Methodist, Houston, TX
Tumors arising from the Inferior vena cava(IVC) are rare. Differential diagnosis includes Leiomyosarcoma, Myxoma, Rhabdomyoma, Leiomyomatosis and Thrombus. Apart from the location of the tumor, the pathology of the tumor can guide the exposure and magnitude of the operation. We report the use of a robotic catheter to direct biopsy forceps inside the cava and to perform a biopsy from an IVC tumor whose extent was defined by dynamic magnetic resonance(MR) imaging. We then describe our technique of open resection and reconstruction of the IVC in 2 cases.
In our narrative video, we describe our technique of endovascular biopsy of an IVC tumor followed by open resection and reconstruction. The 1st approach was using right heart bypass for a retrohepatic caval tumor extending into the right atrium. The 2nd approach was using a complete heart bypass under hypothermic circulatory arrest for a more extensive IVC tumor extending from the iliac confluence into the right atrium and required radical resection of infrarenal cava with replacement.
Resection of the IVC tumor was performed in 2 patients and though their immediate postoperative course was complicated by renal failure, they have both recovered renal function. One of the two patients is 6 months out from her surgery and is back to baseline functional status.
Resection of an IVC leiomyosarcoma can be associated with significant morbidity, especially if the extent is retrohepatic and into the right atrium. Preoperative planning is helpful using dynamic MR imaging and endovascular biopsy. Open resection of IVC tumors can be safely performed with a close collaboration between cardiac and vascular surgeons. Only about 300 cases of IVC Leiomyosarcoma have been described in the literature and resection of these tumors, both radical and palliative, have been described to prolong survival. Further long term data and follow up are needed.
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