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Autogenous Arterial and Venous Reconstruction for Femoral Vein Leiomyosarcoma—A Case Report

Department of Surgery, Wilford Hall Medical Center USAF, Uniformed Services University of the Health Sciences, Lackland AFB, Texas, propper{at}uthscsa.edu

David Zonies, MD, MS, MPH

Department of Surgery and Surgical Oncology, Uniformed Services University of the Health Sciences, Lackland AFB, Texas

David Smith, MD

Department of San Antonio Military Vascular Surgery, Uniformed Services University of the Health Sciences, Lackland AFB, Texas

Todd E. Rasmussen, MD, FACS

Harborview Medical Center, University of Washington, Washington

This report describes the removal of a large, symptomatic leiyomyosarcoma arising from the proximal femoral vein necessitating removal of the femoral venous and arterial circulations. Reconstruction was accomplished with autologous vein and initial coverage with ipsilateral rectus abdominus flap. Persistent, early postoperative lymphatic leak and groin sepsis secondary to staph aureus was managed with reoperation and coverage with contralateral rectus abdominus muscle flap. Negative pressure dressing device was used as a wound management adjunct and splint thickness skin graft providing final successful coverage. Two years following the operation the patient was without evidence of disease, had a patent vascular reconstruction and a well healed groin. Femoral vein leiyomyosarcoma is a rare vascular tumor, which is especially challenging to manage in the proximal location. Successful outcome is predicated on revascularization with autologous vein and on a multidisciplinary approach using various soft tissue coverage strategies and wound management adjuncts.

Key Words: leiomyosarcoma • venous tumor • femoral reconstruction • groin sepsis

This version was published on April 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 2, 215-220 (2009)
DOI: 10.1177/1538574408328167


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