Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients

Ferreira, Ubirajara; Reis, Leonardo Oliveira; Ikari, Lia Yumi; Silva, Walter da; Matheus, Wagner Eduardo; Denardi, Fernandes; Stopiglia, Rafael Mamprim; Menezes, Fábio Husseman

doi:10.1007/s00345-008-0282-z

Cited by 13 publications

(13 citation statements)

References 22 publications

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“…Metastatic SCC of the inguinal lymph node has been frequently reported in penile cancer. 3,4) In our patient, therefore, lymph node metastasis of penile cancer was most suspected, however, a definite abnormality was not identifiable even by FDG-PET/CT in the penis.…”

Section: Discussionmentioning

confidence: 59%

“…2) However, a metastatic inguinal lymph node carcinoma frequently involves the femoral vessels in its advanced stage and leads to massive bleeding and even death. 3,4) with a blood pressure of 72/38 mmHg and an irregular heart rate of 116/min. The eroded ulceration of the left groin was 5 × 5 cm in size and emitted a foul odor resulting from infection and necrosis.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Femoral Arterial Bleeding by an Unknown Origin Metastatic Groin Lymph Nodes Carcinoma

Nakamura

Oda

Yasunaga

et al. 2016

Annals of Vascular Diseases

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We report a case of femoral arterial bleeding complicated with hemorrhagic shock caused by bacterial infection attributed to an inguinal lymph node metastasis of carcinoma of unknown primary. Because of severe preoperative condition, a venous patch plasty of ruptured artery, and omentopexy for the groin was performed as a less invasive surgery. But the recurrence of bleeding was occurred postoperatively. A staged operation, hemostasis with a venous patch plasty at a first stage, and an extra-anatomical bypass soon after improvement of shock condition in a second stage, can be one of surgical procedures to save the lives and salvage limbs. Keywords: femoral arterial bleeding, groin lymph nodes, groin infectionIn this paper, we report a case of femoral arterial bleeding caused by bacterial infection attributed to an inguinal lymph node metastasis of a CUP in an elderly patient. Case ReportA 79-year-old man was emergently transferred to our hospital for treatment of pulsatile massive bleeding from the eroded ulceration in the left groin with hemorrhagic shock. He noticed swelling of the lymph nodes in the left groin 15 months previously, and then the patient was diagnosed with metastatic carcinoma of the lymph nodes, which was pathologically classified as squamous cell carcinoma (SCC), after biopsy of the affected lymph node. Despite of close examinations using extensive diagnostic procedures, which included measurement of tumor markers, ultrasonography, computed tomography (CT), magnetic resonance imaging, gastrointestinal endoscopy, and combined 18 F-fluorinefluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT), the primary origin was not identified. FDG-PET showed high levels of FDG uptake in the left groin but significant FDG uptake was not detected in any other site such as the abdomen, the genitals and the lower extremities (Fig. 1). Based on these findings, a diagnosis of CUP with inguinal lymph node metastasis was made, and radical inguinal lymphadenectomy was judged to be difficult. Then, the patient underwent radiation therapy, but it was not effective to suppress expansion of the metastatic lymph node carcinoma. During the following 7 months, the expanded metastatic lymph node carcinoma eroded the skin with occurrence of ulceration, infection, and femoral vessel involvement. A small amount of bleeding from the ulceration repeatedly occurred during the last 4 months. CT performed one month previously revealed the large, irregular and poorly bordered mass extended from left pelvic region to the left groin with necrosis of its central part with involvement of the iliac and femoral arteries and a fistula to the skin ( Fig. 2A). Thrombosis of the left femoral and iliac veins and cancerous invasion to the pelvis were also demonstrated on CT (Figs. 2B, 2C). On admission, the patient was in circulatory collapse

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

A Case of Femoral Arterial Bleeding by an Unknown Origin Metastatic Groin Lymph Nodes Carcinoma

Nakamura

Oda

Yasunaga

et al. 2016

Annals of Vascular Diseases

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“…Ulceration of nodes and fixity occurs in the later stages of malignancy. Blowout of the underlying femoral vessels is one of the terminal events in such cases [3,4]. There are some peculiarities in this patient.…”

Section: Discussionmentioning

confidence: 73%

Ulcerated Nodal Metastasis in Penile Carcinoma

K¹,

Madhu²

2011

OJU

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A 35 year old male patient presented with untreated ulcerative lesion over the penis of one year duration with ulcerations over bilateral groin and suprapubic areas of three months duration. Biopsy was reported as squamous cell carcinoma. Involvement of nodes along suprapubic area is rare and is found ulcerated in this case. Ulceration of nodes and fixity occurs in the later stages of malignancy. Blowout of the underlying femoral vessels is one of the terminal events in such cases. This patient underwent bilateral ilioinguinal node dissection, total penoscrotal amputation and bilateral flap cover with tensor fascia lata flap

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“…However, we agree that obturator bypass represents one of the best time honored treatment options when complex infections occur in the groin [ 5 ]. The literature reports have suggested that obturator bypass is safe, effective and durable method with primary patency rates of 76% at 24 months in clinical series [ 3 , 8 – 10 ]. In addition, the literature regarding mortality rates ranges from 0% to 17% [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Aortobifemoral Reconstruction with Right Extra-Anatomic Obturator Foramen Bypass due to a Septic Groin

Hinojosa

Anaya‐Ayala

Laparra-Escareño

et al. 2016

VSI

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The aortic bifurcation and iliac vessels are common sites of atherosclerotic occlusive disease causing the clinical expression known as “Leriche’s syndrome”. An aortobifemoral bypass grafting in the setting of a septic groin remains a significant challenge to vascular surgeons. We present a 65-year-old male with complete occlusion of the distal aorta and iliac arteries; he had undergone a left axillo-femoral and femoral-femoral artery bypass 2 years prior to our evaluation. Owing to a complex graft infection in the right groin and worsening lower extremity ischemia, we performed an aortobifemoral reconstruction through the right obturator membrane. This report highlights the safety and efficacy of the obturator bypass for avoiding infected groins while preserving vascular continuity and durability with 78 months of secondary patency rate.

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Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients

Abstract: The use of the transobturator bypass can benefit patients presenting with penile SCC and inguinal lymph nodes metastasis involving the femoral vessels, allowing resection of extensive tumor lesions, as well as avoidance of local complications.

Cited by 13 publications

References 22 publications

A Case of Femoral Arterial Bleeding by an Unknown Origin Metastatic Groin Lymph Nodes Carcinoma

A Case of Femoral Arterial Bleeding by an Unknown Origin Metastatic Groin Lymph Nodes Carcinoma

Ulcerated Nodal Metastasis in Penile Carcinoma

Aortobifemoral Reconstruction with Right Extra-Anatomic Obturator Foramen Bypass due to a Septic Groin

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