Vascular reconstruction in limbs with malignant tumors.
Patients with tumors in limbs who undergo surgical treatment may present involvement of major vessels. Major arteries must be reconstructed for limb salvage. Major veins may be reconstructed to avoid the onset of venous hypertension. The objective of this study is to analyze the results from surgical treatment of malignant tumors associated with vascular reconstruction in limbs. A prospective follow-up was made of 20 patients with malignant tumors involving major vessels in limbs who underwent vascular reconstruction. Arterial and venous reconstructions were performed in 11 patients, arterial reconstruction in 7, and venous reconstruction in 2. The vascular substitutes utilized were: greater saphenous vein (21), expanded polytetrafluoroethylene (ePTFE) prosthesis (5), and Dacron prosthesis (5). Vascular complications occurred in 9 patients: 1 rupture of the arterial graft, 4 occlusions of the venous graft, and worsening of previous edema in 4 patients. Nonvascular complications occurred in 6 patients: infection (2), neurologic deficit (2), partial necrosis of the flap (1), and enteric fistula (1). Four patients presented local recurrence, and 1 of them underwent transfemoral amputation. Seven patients presented pulmonary metastases, of whom 4 died. Arterial revascularization in association with the resection of limb neoplasm is a safe procedure with a low rate of complications. Venous revascularization should be performed using an autologous substitute.
Nishinari
Kenji
K
Department of Vascular Surgery, Hospital do Câncer A.C. Camargo, São Paulo, Brazil. marken@uol.com.br.
Wolosker
Nelson
N
Yazbek
Guilherme
G
Zerati
Antônio Eduardo
AE
Nishimoto
Inês Nobuko
IN
Penna
Valter
V
Lopes
Ademar
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D034941:Upper Extremity / Q000098:blood supply*
D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene