Intravascular Leiomyomatosis: the Surgical Challenge of Tumors With Cavoatrial Extension

Intravenous leiomyomatosis with inferior vena cava and heart extension

“…One-stage operations also have many shortcomings, however, including longer operation time, increased trauma, more bleeding, and more postoperative complications. 11,16 In our group, the three cases of one-stage surgery were successful, but the blood loss was relatively more (Fig 2).…”

“…For slowgrowth tumor, some authors have waited up to 6 weeks to undertake the second stage. 16 In the first patient who underwent a two-stage operation, the first stage was the abdominal hysterectomy and the tumor resection via the vena cava. Because the tumor grew into the heart, we could not drag the tumor out from the atrium during the first stage of operation.…”

“…Although staging the operation can avoid the shortcomings of a one-stage procedure, it may pose a threat due to possible tumor emboli. 16 A temporary filter is an optional method in the first stage of surgery, then the tumor resection would be performed through the infrarenal vena cava after an interval; however, this technique is not recommended routinely.…”

Infrarenal Transcaval Extraction of Intracardiac Leiomyomatosis

“…Because 1-stage surgery is not appropriate for critical conditions, such severe heart failure and syncope, the 2-stage procedure should be performed as early as possible to reduce the risk of sudden death and venous thromboembolism. 14 The 2-stage surgery included an upper and lower renal vein stage, with an interval of time decided according to the patient's recovery status (6 weeks for some authors) to undertake the second stage 10,15 with less of a risk of residual recurrences. 16,17 This paper presents a technique that stabilizes the tumor and creates an ample area for traction and with it the certainty of avoiding embolism and achieving total removal.…”

Leiomyomatous Tumors of the Hepatobiliary Tract

“…Involvement of the venous outflow tract of the liver may be expected in those cases where IVL extends from uterine and/or pelvic veins to the cavoatrial system, with extension of the tumors into the heart cavities, which is a well-known complication of this tumor and may cause cardiac failure and death via valvular obstruction (Mandelbaum et al 1974;Saitoh et al 2004;Vallejo et al 2005;Demirkiran et al 2013;Xu et al 2013). The tumor may show extensive intracaval attachment in these situations (Nam et al 2003) and the sometimes large tumor plug may obturate hepatic vein entry in the caval vein (Vallejo et al 2005). Direct involvement of the hepatic veins has been described in a 66-year-old woman (Bahary et al 1982) and in a patient who had developed Budd-Chiari syndrome (Kuenen et al 1996).…”