title: Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities.
abstract: BACKGROUND
  Limb-sparing procedures are currently considered the standard treatment for lower limb soft tissue sarcoma (STS). Surgical excision combined with vascular resection may be necessary to provide an adequate safety margin and to improve the oncologic outcomes. In this scenario, vascular reconstruction is required to preserve limb function. We evaluated the long-term patency and survival outcomes of arterial and venous reconstruction after resecting lower limb STS in the largest single-center case series to date.
  
  
  METHODS
  Between November 1995 and July 2014, 25 patients with lower limb STS and vascular invasion underwent surgical resection followed by arterial or venous reconstruction. Patients were followed up at regular outpatient visits, at which clinical examinations and duplex ultrasound mapping were performed to assess graft patency.
  
  
  RESULTS
  A total of 44 revascularization procedures were performed. The median follow-up time for the arterial and venous groups combined was 25.2 months (range, 0.26-225.6 months). The 5-year survival probability was 42.1%. The graft occlusion rate was significantly higher after reconstruction with synthetic grafts than after reconstruction with saphenous vein substitutes (P = .02). The occlusion rate was not significantly different between arterial reconstruction and venous reconstruction (P > .05).
  
  
  CONCLUSIONS
  Arterial and venous reconstruction is feasible after surgical resection of lower limb STS. Vascular reconstruction provides favorable long-term patency outcomes and low complication rates, allowing limb preservation and disease control in a select group of patients. Vascular reconstruction using venous grafts had a significantly higher patency rate than reconstruction with artificial venous substitutes.
authors.affiliation: Division of Vascular and Endovascular Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishinari
authors.affiliation: Division of Vascular and Endovascular Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil. Electronic address: mariana.krutman@gmail.com.
authors.forename: Mariana
authors.initials: M
authors.lastname: Krutman
authors.affiliation: Division of Surgical Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aguiar Junior
authors.affiliation: Division of Vascular and Endovascular Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Bruno Soriano
authors.initials: BS
authors.lastname: Pignataro
authors.affiliation: Division of Vascular and Endovascular Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Yazbek
authors.affiliation: Division of Vascular and Endovascular Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Guilherme Andre
authors.initials: GA
authors.lastname: Zottele Bomfim
authors.affiliation: Division of Vascular and Endovascular Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Marcelo Passos
authors.initials: MP
authors.lastname: Teivelis
authors.affiliation: Division of Vascular and Endovascular Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D001938:Brazil; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D055815:Young Adult