Primary Inferior Vena Cava Leiomyosarcoma Presenting with Proximal Occlusion with Deep Venous Thrombosis and Lower Extremity Edema: Reconstruct vs Ligate Post Resection? A Single Retrospective Case Report

Abstract

Introduction: Primary leiomyosarcomas of the inferior vena cava (IVC) are rare tumors with a poor prognosis. Curative treatment remains surgical resection with clear margins. Reconstruction vs ligation of the IVC is debatable, especially if the proximal IVC is occluded. This report presents the surgical management of a patient presenting with acutely worsening lower extremity edema and biopsy proven IVC leiomyosarcoma. Methods: This is a retrospective chart review, and the patient was followed up at 2 weeks and at 3 months. Patient provided consent for creation of this case report. Results: The patient’s age at presentation was 67 years and she was of female gender. The IVC leiomyosarcoma had a maximum diameter of 4.8cm, involved the infrarenal IVC only, and the proximal segment was occluded due to bilateral iliofemoral deep venous thrombosis (DVT). She underwent an R0 resection, with immediate reconstruction using 14mm ringed PTFE. Postoperatively, she was noted to have worsening lower extremity edema. The plan was to recanalize her DVTs via endovascular thrombectomy and stenting, however the patient’s edema improved with compression alone. At 2 weeks follow up, her edema had completely resolved. At 3 months follow up, postoperative CT scan showed expected occluded infrarenal IVC graft, and no evidence of recurrent disease. Conclusion: Reconstructing the occluded IVC after resection of the primary IVC leiomyosarcoma gives the patient the option for future endovascular recanalization if there is ongoing lower extremity edema. Further follow up and research is warranted to determine if this provides a feasible long-term solution.