Beware Of The Rare Intravascular Leiomyomatosis Causing Iliocaval Obstruction
Akiko Tanaka, M.D.1, Tam T. Huynh, M.D.2.
1McGovern Medical School at UTHealth, Houston, TX, USA, 2The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Acute iliocaval thrombosis is a well-recognized vascular event. A less well-known, rare form of iliocaval obstruction is caused a pelvic leiomyoma tumor (fibroid), which grows intravascularly via direct extension into the internal iliac or ovarian vein. This condition is known as intravascular/intravenous leiomyomatosis (IVL).
We present the case of a 51-year-old woman with extensive IVL obstructing the left common iliac vein and IVC. The patient had a failed pharmacomechanical thrombectomy, and a filter was placed in the supra-renal IVC. In this video, we show successful open surgical tumor thrombectomy to remove the IVL, extraction of the suprarenal filter, and primary reconstruction of the IVC and left common iliac vein. The diagnosis of IVL should be considered in women who have uterine leiomyomas and develop iliocaval obstruction. Although IVL is slow-growing and devoid of metastatic potential, it can continue to grow and occlude the IVC, and/or block the right atrium and ventricle. Open surgical tumor thrombectomy to completely remove IVL is recommended. In contrast to vascular leiomyosarcoma which involves the vessel wall, IVL does not invade the vessel wall. Generally, IVL can be removed through a long venotomy (without wall resection), which can be closed primarily. Percutaneous pharmacomechanical thrombectomy and placement of IVC filter are contra-indicated in IVL.
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