Inferior Vena Cava Resection and Reconstruction for Retroperitoneal Tumor Excision

Abstract

36 months. True lumen volume increased progressively in both group A (114 mL to 174 mL), and group B (124 mL to 190 mL) from baseline to 36 months. False lumen volume decreased in group A (150 mL to 88 mL) and group B (351 mL to 250 mL), respectively; while total thrombus load in the false lumen increased from 73% to 80% for group A and 84% to 87% in group B in 3 years. Eight patients (4 in each group) showed an increase in total aortic volume of Ͼ10%. Twelve patients showed a static volume and 12 patients showed a shrinkage. Aortic volume change had no relationship to pathology, stent graft sizing, and thrombus load, but was positively associated with the placement of a longer graft. There was a small but progressive distal migration of stent grafts in all patients (3.1, 4.5, and 4.6 mm at 6, 12, and 36 months), more prominent in shorter stent grafts (Ͻ160 mm). No mortality, rupture, or secondary interventions occurred during follow-up.Conclusions: Aortic remodeling after TEVAR in chronic dissection is a continuous process. There were no significant differences between chronic dissections and aneurysms in all volumetric parameters. Treating chronic dissections early before aneurysm formation did not seem to have a morphologic advantage.Objective: Reintervention rates are higher for endovascular aneurysm repair (EVAR) compared with open repair (OR) due to endoleak treatments, while surgical reoperations for bowel obstruction and abdominal hernias are higher after OR. However, readmission rates for nonoperative conditions after aneurysm repair are not well documented. We sought to determine reasons for statewide nonoperative readmissions within the first year after open abdominal aortic aneurysm (AAA) repair and EVAR.Methods: Patients who underwent an elective AAA repair in California over a 4-year period were identified from the Office of Statewide Health Planning and Development (OSHPD) administrative database. All patients who had a readmission within 1 year were included for evaluation. Readmission rates as well as diagnoses associated with each readmission were analyzed and recorded.Results: From 2005 to 2008, there were 22,972 operations for elective aneurysm repair, 13,454 EVAR (59%), and 9,518 OR (41%). Postoperatively, there was a 30% readmission rate following OR and a 28% readmission rate after EVAR (P ϭ .02). The most common principle diagnoses associated with readmission after either type of AAA repair were infection (14.5%), cardiac problems (13.7%), and failure to thrive (12.7%). Patients who underwent OR were more likely to be readmitted with diagnoses associated with failure to thrive (P Ͻ .0001), gastrointestinal complications (P Ͻ .0001), wound infection (P ϭ .04), and small bowel obstruction (SBO; P Ͻ .0001). Those who underwent EVAR were more likely to be readmitted with diagnoses of cardiac conditions (P Ͻ .0001), device-related complications (P Ͻ .0001), cardiovascular accident (CVA) (P ϭ .011), and renal complications (P Ͻ .0001).Conclusion: Nonoperative readmission rates within 1 year of e...

Resection of retroperitoneal sarcoma en‐bloc with inferior vena cava: 20 year outcomes of a single institution

“…While tumor resection en‐bloc with major vascular structures increases case complexity, studies in numerous other malignancies have shown survival rates following major vascular resection that are comparable to those without vascular involvement . Similar findings have been reported in multiple small case series of multivisceral RPS resections performed at high volume institutions . However, due to the rarity of this disease, present existing series are often small in size, include extremity sarcomas in analyses, or investigate primary leiomyosarcoma of the IVC only.…”

Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: A case series and review of the literature

“…One study of eight patients undergoing resection for malignancy with PTFE graft reconstruction reported 75% late patency rates, with the thrombosed grafts causing no edema . As vascular surgery technology has improved, graft reconstruction has become a progressively better option; a very recent study of 47 patients who underwent en bloc resection of the IVC for malignancy demonstrated 92% clinical patency rates at 5 years, with 0% mortality and 2% graft‐related complication rate . We therefore favor repair or reconstruction whenever possible, as this restores continuity of the IVC and minimizes the comorbidity associated with ligation.…”

Resection of a Giant Primary Synovial Sarcoma of the Inferior Vena Cava Extending Into the Right Atrium With Caval Reconstruction Under Cardiopulmonary Bypass and Circulatory Arrest

“…When reconstructing the involved portion of the IVC during surgical resection of retroperitoneal sarcomas, 2 options are available: total replacement of the involved portion of the cava with a tube graft, typically composed of polytetrafluoroethylene (PTFE), with preference given to one with external support (ringed), 14,15 or longitudinal cavotomy and closure using either an autologous or prosthetic patch material after complete tumor excision. The advantage of the second strategy is the speed and lack of need for reimplantation of the hepatic veins, which minimize the risk of anastomotic complications that may include bleeding from multiple suture lines, postoperative hepatic vein obstruction, or thrombosis.…”