Society For Clinical Vascular Surgery

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Leiomyosarcoma of the Vena Cava in a 49 Year Old Female
Laurel H Hastings1, Amit Chawla1, Joseph F Buell2, Marie E Unruh1, Malachi G Sheahan1
1Louisiana State University Health Sciences Center, New Orleans, LA, USA; 2Tulane University Medical Center, New Orleans, LA, USA

A 49-year-old female presented with one week of cramping abdominal pain. Imaging showed a large retroperitoneal mass encompassing the inferior vena cava that demonstrated peripheral enhancement, concerning for a leiomyosarcoma. Utilizing a multi-disciplinary team of Vascular and Hepatobiliary Surgery, she was taken for resection. After mobilization of the hepatic flexure and duodenum, a large IVC tumor originating from the cava’s right lateral wall was noted, and which had extensive neovascularization along its anterior and lateral aspects. The cava was fully mobilized from the retro-hepatic portion cranially to the healthy cava caudally as well as bilateral renal veins. The tumor was milked from the retro-hepatic cava, control was obtained, and the infra-hepatic cava was transected and removed. A 20mm ringed PTFE graft was used as an interposition graft with the renal veins sewn in via an end-to-side fashion. Her post-operative course was complicated by ileus. Pathology was consistent with leiomyosarcoma.

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