Current Treatment of Retroperitoneal Sarcomas by Vittorio Quagliuolo & Alessandro Gronchi

Author:Vittorio Quagliuolo & Alessandro Gronchi
Language: eng
Format: epub
Publisher: Springer Milan, Milano

IVC ligation is usually feasible and well tolerated when the vessel lumen is already occluded; in such cases it is mandatory to preserve the collateral venous drainage during surgical maneuvers [41]. On one hand, this approach prevents the occurrence of pulmonary thromboembolism and does not require lifelong anticoagulation, as well as avoiding graft-related complications [6]. On the other hand, significant edema of lower extremities has been reported in up to 50% of patients undergoing IVC ligation [42]. Our surgical policy usually favors vein ligation without reconstruction when the preoperative study demonstrated a non-patent IVC, confirmed by the intraoperative finding [9] (Figs. 7.2, 7.3). However, there is still no agreement on this issue, since different surgical policies and incidence rates of lower limb edema are described in the literature [9, 10].

When ligation is not indicated and the IVC needs to be replaced, several reconstruction techniques can be employed. The positioning of a PTFE prosthetic graft is one of the most common methods for replacing the IVC [14, 38, 43] (Fig. 7.4). of the graft — which is one of the main concerns in venous reconstruction — some authors suggested ring-reinforced PTFE grafts while others reported the fashioning of an inguinal arteriovenous fistula in order to enhance blood flow and pressure within the graft [44]. Another rare but potentially life-threatening complication following prosthetic reconstruction is graft infection, whose incidence is higher when concomitant bowel resection is performed [14, 43]. In this scenario, omental interposition between the graft and resected viscera may be helpful in lowering the infection rate [44].

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