Venous reconstructions in lower limbs associated with resection of malignancies.
BACKGROUND
Patients with tumors in the limbs who undergo surgical treatment may have involvement of major vessels. Major arteries are always reconstructed for limb salvage. Major veins may be reconstructed to avoid the onset of venous hypertension signs and symptoms. The objective of this study was to analyze the results from surgical treatment of a sample of patients who underwent lower limb venous reconstructions associated with the resection of malignant tumors.


METHODS
Follow-up was performed of 17 patients with malignant tumors involving major vessels in the lower limbs. The median length of follow-up was 22 months. Venous reconstruction concomitant to arterial reconstruction was performed in 15 patients, and an isolated venous reconstruction was performed in 2 patients. The venous substitutes used were the contralateral long saphenous vein (n = 12), expanded polytetrafluoroethylene prosthesis (n = 3), and Dacron prosthesis (n = 2).


RESULTS
Vascular complications occurred in seven patients: three occlusions of the venous graft, edema in seven patients, and one rupture of the arterial graft. The primary 2- and 5-year patency rates of venous reconstructions were 79.3% and 79.3%, respectively. Nonvascular complications occurred in six patients: neurological deficit (n = 3), partial necrosis of the flap (n = 2), wound infection (n = 1), hematoma (n = 1), and enteric fistula (n = 1). Eight patients were still alive and disease free, although one of them underwent above-knee amputation as a result of local disease recurrence. One patient experienced regional disease recurrence and is undergoing chemotherapy. Eight patients died due to pulmonary metastases. The 2- and 5-year overall survival rates were 58.6% and 42.4%, respectively. The 2- and 5-year thrombosis-free survival rates were 51.9% and 35.2%, respectively.


CONCLUSIONS
Lower limb venous reconstructions associated with tumor resection in this study gave good functional results, although the prognosis for these patients had been unfavorable. The saphenous vein is a suitable 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
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D001859:Bone Neoplasms / Q000150:complications / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000150:complications / Q000601:surgery*; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D013584:Sarcoma, Synovial / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome