Vascular reconstruction for limb salvage in sarcoma of the lower extremity
T. Koperna, B. Teleky, S. Vogl, R. Windhager, F. Kainberger, K. D. Schatz, R. Kotz and P. Polterauer
Department of Vascular Surgery, University of Vienna, Austria.
OBJECTIVES: To examine the patency and limb-salvage characteristics of
vascular reconstruction in patients with sarcomas of the lower extremity
who had been treated with limb-preserving resection and to examine patient
survival during a long follow-up period. DESIGN: Retrospective cohort
study. SETTING: University hospital, tertiary referral center. PATIENTS:
From 1984 to 1992, 14 patients underwent limb-preserving resection of
sarcomas in the proximal lower extremity, with 20 vascular reconstructions
performed. OUTCOME MEASURES: Color Doppler scans documented patency of the
vascular reconstructions. Clinical evaluation included functional results
in terms of limb movement and quality of life. Local tumor control and
systemic recurrence were examined by repeated radiologic examination.
Overall survival as well as time and cause of death were assessed. RESULTS:
A total of 13 patients had patent vascular grafts, while the venous graft
became occluded in 1 patient. Limb function was rated as excellent or good
in 9 patients, as fair in 3, as poor in 1, and could not be clinically
estimated in 1. Postoperative thrombosis of the venous graft was detected
in 3 patients and was effectively managed by thrombectomy in 2. Three
patients underwent reoperation because of hematoma or complications caused
by local infection. The tumor endoprosthesis had to be replaced in 3
patients. During follow-up periods that ranged from 15 to 132 months (mean,
55 months), 4 patients died. In all of these patients the cause of death
was systemic recurrence in the lung. Two additional patients developed
pulmonary metastases, but at the time of this report, they were still alive
as long as 132 months after operative resection or chemotherapy. No local
recurrence was found. CONCLUSION: Limb-preserving resection of sarcoma of
the lower extremity can be performed with satisfactory function of the limb
maintained, even if it becomes necessary to resect the femoral vessels.
Autologous venous graft for vascular reconstruction is the treatment of
choice. In spite of the high incidence of metastases, considerable
long-term survival is possible.
