Limb-preserving vascular surgery for malignant tumors of the lower extremity
J. G. Fortner, D. K. Kim and M. H. Shiu
Monobloc soft-part resections have been carried out with excision of
segments of the illac and femoral vessels in seven patients with cancer in
the lower extremity. Amputation would have been necessary otherwise.
Ischemic loss of the extremity did not occur. In four of the earlier
patients, vascular reconstruction was not performed, and postoperative
lymphedema was a major complication. In the recently treated three
patients, complete reconstitution of the circulation by simultaneous
arterial and venous grafting permitted smooth postoperative recovery and
absence of notable edema. Creation of a distal arteriovenous fistula
appears essential to maintain venous patency. Six of the seven patients are
alive at six months, 1, 3, 4, 7, and 18 years, respectively. One patient
died of pulmonary metastases at three years after operation. Two patients
developed local recurrences requiring limb disarticulation, both in the
earlier group in which excision and grafting of both artery and vein was
not done. It is concluded that excision and simultaneous reconstruction of
major blood vessels can extend the scope of soft-part resections for cancer
of the extremities, offering opportunities for preservation of limbs that
would otherwise require amputation for control of disease.
