vascular reconstruction with the superficial femoral vein following major oncologic resection

Journal of Surgical Oncology 2007;96:151–159

Vascular Reconstruction With the Superficial FemoralVein Following Major Oncologic Resection

ANDREW McKAY, MD, MSc, FRCSC,1* MONA MOTAMEDI, BA (Hons),2 WALLEY TEMPLE, MD, FRCSC, FACS,1

LLOYD MACK, MD, FRCSC,1 AND RANDY MOORE, MD, MSc, FRCSC2

1Department of Surgery, Division of Surgical Oncology, University of Calgary, Calgary, Alberta, Canada2Department of Surgery, Division of Vascular Surgery, University of Calgary, Calgary, Alberta, Canada

Introduction: Involvement of critical vascular structures has historically beenconsidered a contraindication to tumor resection. This study describes outcomesfollowing radical oncologic resection with concomitant resection of critical vascularstructures and reconstruction with the superficial femoral vein (SFV).Methods: All patients undergoing radical oncologic resection requiring resection ofmajor vascular structures and concomitant reconstruction using the SFV as conduitwere retrospectively reviewed. Primary outcomes were surgical morbidity andmortality; secondary measures included long-term patency and oncologic outcomes.Results: Seven patients were included. There were three retroperitoneal and two groinsarcomas, and two squamous cell carcinomas metastatic to groin lymph nodes. Noperioperative mortality occurred. Five patients experienced minor morbidity. One veingraft in a patient with pre-existing chronic deep venous thrombosis (DVT) occludedpost-operatively. No subsequent long-term venous or arterial graft occlusions occurred(median 20.2 months, range 9.0–49.7). Two patients died of tumor recurrence duringfollow-up.Conclusions: Resection of tumors involving critical vascular structures is feasible.The SFV conduit is a versatile option for major vascular reconstruction, providinggood long-term patency rates with acceptable morbidity and mortality. Vascularresection and reconstruction with the SFV offers another technique to provide limb-sparing surgery in patients traditionally offered only amputation, while providingfavorable oncologic outcomes.J. Surg. Oncol. 2007;96:151–159. � 2007 Wiley-Liss, Inc.

KEY WORDS: sarcoma; retroperitoneal; pelvic; vascular reconstruction;superficial femoral vein

INTRODUCTION

Soft tissue sarcomas are rare neoplasms that presentmajor challenges in their management [1]. The typicallylarge size of retroperitoneal sarcomas at diagnosis, andthe complex anatomy of the retroperitoneal structures canpreclude resection with negative margins [1,2]. In themajority of resectable cases, en-bloc resection ofcontiguous organs is necessary to remove all grossdisease. This often requires resection of critical vascularstructures. Similarly, for extremity sarcomas or othertumors with contiguous involvement of the femoralsheath, major vascular resection and reconstruction isrequired for limb sparing and in order to achieve clearmargins [3].

Historically, invasion of critical vascular structures hasbeen considered a relative contraindication to tumorresection. Vascular invasion by limb sarcomas was onceconsidered an indication for amputation [4]. Such vascularreconstructions have been limited by the theoreticalincreased risk of occult hematogenous dissemination, andby the lack of available conduit, with the increased risks

*Correspondence to: Andrew McKay, MD, MSc, FRCSC, Division ofSurgical Oncology, Tom Baker Cancer Centre, 1331—29 Street NW,Calgary, AB, T2N 4N2, Canada. Fax: 403-283-1651.E-mail: [email protected]

Received 4 October 2006; Accepted 17 January 2007

DOI 10.1002/jso.20788

Published online 18 April 2007 in Wiley InterScience(www.interscience.wiley.com).

� 2007 Wiley-Liss, Inc.

of prosthetic graft infection in the presence of gastro-intestinal or genitourinary tract resections that maybe required for resection margin. Modern vascular-reconstructive techniques allow concomitant resectionand reconstruction of major vascular structures withacceptable morbidity and mortality, with long-termoutcomes dictated mainly by the biology of the resectedtumor [5–9]. Autologous vein grafting is the preferredmethod of reconstruction, particularly for venous recon-struction, [6] due to the relative resistance to infection,the length of conduit available, and the excellent patencyrates observed. The use of the deep thigh veins, such asthe superficial femoral vein (SFV) as reported bySchulman et al. in 1986 [10], has provided vascularsurgeons with a versatile conduit [11] for lower extremitybypass, particularly in the setting of an infected vascularbed, and has the added advantage of appropriate sizematch for reconstruction of the major proximal-abdominal and pelvic-vascular structures.Based on our favorable experience with the use of

the SFV during resection of infected prosthetic vasculargrafts, we began to utilize this conduit during radicalresection of soft tissue neoplasms requiring concomitantmajor vascular resection and reconstruction. The primaryobjective of this article was to describe the morbidityand mortality of these procedures. Secondary objectivesincluded descriptions of the long-term patency of thevascular repair and the oncologic outcomes. The hypo-thesis of the article was that major oncologic resectionswith concomitant major vascular resection and recon-struction using the SFV could be done with acceptablemorbidity, long-term patency, and oncologic outcomes.

MATERIALS AND METHODS

Design

This article is a retrospective analysis of the outcomesfollowing resection of malignancies that required con-comitant major vascular resection and repair using theSFV at the University of Calgary in Calgary, Alberta,Canada. The study was given approval by the Universityof Calgary Conjoint Health Research Ethics Board.

Subjects

All patients who underwent oncologic resection thatrequired major (abdominal, pelvic, or femoral) vascular(arterial and/or venous) resection were included if thevascular reconstruction was performed using the SFVas aconduit. It was anticipated that the majority of patientswould have soft tissue sarcomas, but patients with anytumor type were considered eligible. The surgical teamrepresents the only service undertaking such oncologicresections in the Health Region, and during the timeframe of the study reconstruction with the SFV was the

standard technique of reconstruction. Thus, the experi-ence reported here represents the experience in the HealthRegion for the study period.

Procedure

Eligible patients were identified through a databasemaintained by a surgical oncology center. Patients under-went radical resection of their soft tissue malignancies asrequired to obtain clear margins. Two operating teamswere employed, one for the tumor resection and one forthe vascular reconstruction. Confirmation of marginwas obtained with intra-operative frozen section. Neoad-juvant chemoradiation was used when possible forextremity lesions in hopes of achieving optimal localcontrol [12]. Similarly, for retroperitoneal sarcomas,neoadjuvant radiation was used when possible with anintra-abdominal spacer to reduce the amount of smallbowel in the radiation fields [13]. Vascular reconstructionwas performed using the SFV for at least one conduit inall cases.Whenever possible, patients had a simple screening

ultrasound to determine patency of the saphenous veinprior to harvest of the SFV in order to prevent thesequelae of critical venous insufficiency. During the pro-cedure, and prior to any vein excision or bypass, the8 MHz Doppler probe was utilized to confirm saphenousvein and SFV patency. Although the total length ofavailable SFV is dependent on the limb length of thepatient, in general we see harvested lengths of 15–30 cmper limb. For extremity lesions or when the iliac/femoralvenous system was sacrificed on one side, the contral-ateral SFV was harvested. Care was taken to preserve theipsilateral saphenous vein, the profunda femoris veinjunction, and the perigeniculate venous collaterals abovethe knee (see Fig. 1). Patients were maintained on

Journal of Surgical Oncology DOI 10.1002/jso

Fig. 1. SFV harvest. Note identification and preservation of junctionwith profunda femoris vein (arrow), in order to minimize post-operative venous outflow impairment. [Color figure can be viewed inthe online issue, available at www.interscience.wiley.com.]

152 McKay et al.

warfarin for at least 6 months post-operatively, along withgrade III (40–50 mmHg) fitted venous compressionstockings, to minimize the risks of thrombosis of thereconstruction, as well as to reduce the risk for proximalor distal deep venous thrombosis (DVT) in the harvestedlimb. At the 6-month follow-up ultrasound assessment, ifthere were no signs of DVT, persistent leg swelling, orvenous outflow impairment, we discontinued the warfarintherapy unless the patient felt strongly about continuingtreatment. We did not utilize combination anti-platelettherapy and warfarin anti-coagulation unless the patientshad concurrent cardiac, peripheral, or extra-cranialcerebrovascular disease that mandated treatment. Afterdiscontinuation of warfarin therapy, we did recommendongoing low dose (81 mg ASA) anti-platelet therapy toprovide low-risk protection from bypass thrombosis orDVT. Follow-up consisted of duplex ultrasound andcomputed tomography (CT) scans every 6 month todetermine patency of the vascular repairs and asses forDVT and to determine tumor recurrence, respectively.

Outpatient cancer center charts as well as hospitalcharts were reviewed. The primary outcome measure ofthe study was post-operative morbidity and mortality,with emphasis on the perioperative morbidity related tothe vascular reconstruction. Long-term vascular patencyand complications rates, tumor recurrence rates, andsurvival were secondary outcomes. Post-operative mor-bidity was graded according to a previously validatedclassification system[14] and mortality was defined as30-day or in-hospital mortality.

Statistical Analysis

Predictors of operative morbidity were analyzed. Con-tinuous variables were analyzed with Student’s t-test, andcategorical variables were analyzed with a chi-square orFisher’s exact test where appropriate. Actual survival andrecurrence rates are presented along with Kaplan-Meierestimates. A P-value of 0.05 was used to define statisticalsignificance.

RESULTS

Between January 2002 and August 2005, a total ofseven patients underwent radical resections of soft tissuemalignancies that required concomitant major vascularresection and reconstruction. All cases involved recon-struction of at least one vessel with the SFVas a conduit.Two patients had aortic resection with reconstructionusing prosthetic grafts. These two patients also hadconcomitant reconstructions of the inferior vena cava(IVC) with SFV grafts. All other vessels were recon-structed with SFV. There were three males and fourfemales with a median age of 64 years (mean 61.8, range37–86). Five patients underwent surgery to remove softtissue sarcomas and two patients had resection of locallymetastatic squamous cell carcinomas. Four of the patientshad neoadjuvant radiation and one had neoadjuvantchemoradiation in efforts to improve local control. Bothpatients who did not receive neoadjuvant radiation hadreceived previous full dose radiation to the surgical fieldsand were not considered candidates for repeat therapy.One patient had a radiation-induced sarcoma followingtreatment for prostate cancer and another had receivedradiation to the inguinal and iliac nodal basin prior toradical resection for a vulvar squamous cell carcinomaapproximately 8 months prior to the current resection ofmetastatic disease. Table I shows the locations of thetumors, the major vessels resected and the means ofreconstruction. Margins were negative on final pathologicexamination in all cases.

The median operating time was 405 min (mean 399,range 202–601) and the median blood loss was 700 ml(mean 1230, range 400–4000). Two patients requiredintra-operative blood transfusion of 4 and 6 units each.Blood loss was higher with retroperitoneal tumors, butthis was not statistically significant.

There were no perioperative deaths and no patient wasadmitted to the intensive care unit. Median length ofhospital stay was 13 days (mean 19, range 10–32). Fiveof the patients (71%) had post-operative complications,


TABLE I. Location of Tumor and Critical Vascular Structures Undergoing Resection and Reconstruction

Primary tumor

Neoadjuvant

treatment Location

Resected

artery

Arterial

reconstruction

Resected

vein

Venous

reconstruction

Sarcoma — Right groin R ext SFV R ext iliac Vein ligated

Iliac/femoral

Squamous cell

carcinoma

Chemo/radiation Left groin L femoral SFV L femoral SFV

Squamous cell

carcinoma

— Right groin R femoral SFV R femoral SFV

Sarcoma Radiation Retroperitoneum — — IVC SFV

Sarcoma Radiation R groin R ext SFV R ext iliac SFV

Iliac/femoral

Sarcoma Radiation Retroperitoneum Aorta Prosthesis IVC SFV

Sarcoma Radiation Retroperitoneum Aorta Prosthesis IVC SFV

SFV for Vascular Repair After Oncologic Resection 153

however, these complications were minor (grade II orless) and none required surgical or radiological interven-tion. Table II shows the complications experienced by thepatients and their severity, according to a previouslyvalidated classification system [14].There were no patients lost to follow-up. After a

median follow-up of 20.2 months (mean 24.9, range9.0–49.7), there have been two local recurrences at 5 and8 months after surgery (see Fig. 2). These patients diedwith local and distant recurrences at 9 and 10 monthspost-operatively, respectively. The remaining five pati-ents are alive and without clinical or radiological evid-ence of disease after a median of 37.1 months (mean 31.1,range 9.7–49.7) (see Fig. 3).One of the venous grafts occluded in the early post-

operative period (post-operative day 2). This patient had ahistory of chronic DVT on the side of the tumor. Atsurgery, fresh clot was present at the proximal margin ofthe resected specimen, (i.e., ileo-caval thrombus) not onthe side of the harvested SFV. We did our best to removeand flush out the offending ileo-caval clot above theresesction margin prior to completing the SFV recon-struction. This complication was treated non-operativelywith anti-coagulation and compression stockings. There

have been no subsequent late venous occlusions or DVT’sand no arterial occlusions to date, and there have been noanastomotic failures of the vascular reconstructions (seeFig. 4). Three patients have had chronic mild leg swellingof the reconstructed limb requiring chronic compressionstockings. No significant swelling of the SFV harvestedlimb has been observed. No patient had a complication ofwarfarin therapy.

DISCUSSION

Soft tissue tumors of the retroperitoneum, pelvis, andfemoral sheath are relatively rare, with challengesspecific to the location of the lesions, the often largesize at presentation, and the anatomic structures involved.While the principle of complete resection with negativemargins is straightforward, the actual task of accomplish-ing this with a functional outcome may be quitechallenging [1]. Incomplete resection with either grosslypositive (R2) or microscopically positive (R1) margins is


TABLE II. Complications Experienced by Five Patients

Patient Complications Gradea

1 Pneumonia II

2 Leg edema I

3 Ileus, UTI II

4 Occlusion of vein graft II

5 Leg edema, ileus I

aThe complications were graded on a scale of I (minor) to V (death).

Grade I complications are minor and do not require pharmacologic

intervention, while Grade II complications are also considered minor

and do need pharmacologic (but not surgical, endoscopic, or

radiological) intervention [14].

Fig. 2. Kaplan-Meier estimate for disease-free survival.

Fig. 3. Kaplan-Meier estimate for overall survival.

Fig. 4. Kaplan-Meier estimate of venous graft survival.

154 McKay et al.

a major predictor of a poor outcome. For both extremityand retroperitoneal sarcomas, failure to achieve acomplete (R0) resection is predictive of both localrecurrence and overall survival [2,15,16]. The anatomicconstraints of the retroperitoneum can preclude completeresection. In the majority of resectable cases, en-blocresection of contiguous organs is necessary to remove allgross disease, which may involve resection of criticalvascular structures [5,17]. For extremity lesions, invasionof neurovascular structures is associated with decreasedsurvival [3] and can preclude limb-sparing surgery evenwith aggressive multi-modal treatment [3,18]. Again,major vascular resection and reconstruction is oftenrequired for proper oncologic margins.

The present series of patients included three withretroperitoneal sarcomas and four with groin neoplasms(two sarcomas and two with metastatic squamous cellcancer), all involving critical vascular structures. In allcases, an aggressive approach with major vascularresection resulted in microscopically clear margins;further, all patients with extremity lesions had successfullimb salvage. Despite having negative margins, twopatients with soft tissue sarcomas (both were high-gradetumors and one was radiation-induced) suffered localrecurrences at 5 and 8 months after surgery. These twopatients died of distant disease at 9 and 10 months post-operatively. This illustrates the aggressive biology ofthese tumors, as well as the difficulty in determiningmargin status with certainty owing to the large size of theresected specimens and the impracticality of microsco-pically assessing the entire surface. Radiation-inducedsarcomas have a particularly poor prognosis [19,20], asdo high-grade retroperitoneal sarcomas [2].

The need for venous reconstruction is controversial.While some recommend routine reconstruction to avoiddisabling lower-limb edema [21], the need seems todepend largely on the amount of collateral venouscirculation that has developed pre-operatively and thatremains after radical resection [17,22]. In patientsundergoing radical resection of groin or extremitymalignancies, venous reconstruction appears to beparticularly important due to the extensive resectionsinvolving both the superficial and deep femoral veins andthe surrounding muscles. In our series, all seven requiredresection of major venous structures to achieve negativemargins (three had resection of the IVC and four hadresection of iliac or femoral veins). Six patients hadvenous reconstruction.

Options for managing the resected vessels includeligation and reconstruction with prosthetic or autologousgrafts. For extremity lesions, autologous grafts have beenshown to provide superior long-term patency ratescompared to prosthetic grafts [6]. For the IVC, someauthors have managed the majority of patients by ligating

the vena cava [23,24]. While many such patients may notdevelop venous insufficiency of the lower limbs,reconstruction may be necessary in those who havenot developed adequate collateral circulation pre-operatively [17,25]. Hardwigsen et al. [26] found markedsymptoms of venous obstruction in three of six patientswho did not have reconstruction following IVC resection.They, along with others [25], advocate caval reconstruc-tion. As opposed to venous reconstructions of theextremity, many authors use prosthetic material for cavalreconstructions [17,26–34]. In the larger series, the long-term patency rates of the reconstructions are very good.Schwarzbach et al. report a long-term patency rate of94% in a series of 24 patients who underwent cavalresection and reconstruction for retroperitoneal sarco-mas [25]. Bower et al. had similar results with a patencyrate of 93% in a series of 29 patients [27]. Other smallerseries where caval reconstructions performed withprosthetic grafts have shown higher graft occlusion ratesthat ranged between 25% and 100% [24,26,34]. Thepresent series cannot answer whether autologous graftsfor IVC replacements might result in higher long-termpatency rates, although this is a theoretical advantage andis one of the principal reasons for the use of SFV at ourinstitution.

In this series, the SFV was used for all venousreconstructions (three caval and three iliofemoral recon-structions). The SFVoffers several advantages in vascularreconstruction. It is an autologous, large-caliber conduitthat is resistant to infection, kinking and thrombosis [35].Its use was described by Schulman in 1986 for lowerextremity bypass in 42 patients [10]. They reportedsuperior patency rates in the first two years, whencompared to the traditional greater saphenous vein (GSV)conduits.[36] After an initial learning phase, their resultswere even better, and 3-year patency rates were above80% (compared to 67% for GSV grafts). In addition, theyreported no significant late morbidity. They did note thatlarger vein grafts, above a diameter of 1.3 cm, did yieldinferior patency rates for reconstructions below the groin,and recommended avoiding using excessively large graftsin this location. Others have reported favorable outcomesfollowing use of the SFV for conduits. Modrall et al.reported improved symptom control and patency follow-ing the use of SFV compared to GSV for mesentericarterial bypass [35]. The autologous nature of the SFVhas been shown to yield favorable results in the presenceof a contaminated or infected vascular bed [37], even formajor aortic resection [38].

The morbidity associated with using the SFV as aconduit for reconstruction appears to be acceptable.While the majority five of seven) patients experiencedpost-operative complications, these were all consideredmild and most were related to the nature of the oncologic



resection rather than the SFV reconstruction. Threepatients reported mild chronic leg edema that persistedyears after the surgery, although this mainly affected thereconstructed limb, rather than the harvested limb. In allcases, this was treated with fitted compression stockings.The etiology of leg edema is multi-factorial, and isrelated to prior radiation therapy and the combination ofradiologic and mechanical damage of lympatics duringradical resection, as well as impairment of venousoutflow after SFV harvest. Edema in the one patient withearly post-operative venous occlusion was related to DVTpresent at the time of the resection. Six of the venousrepairs remained patent over the long term. The radicalresections included extensive amounts of soft tissuesurrounding the vessels, which would have disrupted thelymphatic return from the limb significantly. Lymphe-dema of the leg is a well-known complication followinggroin dissection for melanoma, occurring in up to 40% ofcases [39]. Others have also reported that resection of thesoft tissue around the femoral vessels significantlyincreased the incidence of problematic lymphedema [22].Despite concerns regarding resection of the major

venous conduit from the lower extremity, the risk of long-term venous morbidity after SFV harvest appears to beminimal [10,40], particularly when the junction with theprofunda femoris vein, and the peri-geniculate venouscollaterals are preserved. We likewise did not observe anymajor venous morbidity, including DVT, in the harvestedlimb. While acute venous hypertension must be mon-itored in all patients, the need for fasciotomy forcompartment syndrome appears to be highest in patientswith severe limb ischemia who undergo harvest of bothdeep veins and the GSV [11]. Operating time is increasedby using the SFV as a conduit. While we did not pros-pectively track the additional operative time, we estimatethat it is in the range of 30 min. We do not consider thisprohibitive, especially since the vascular surgical teamoften had to wait to do the final excision of the vein graftuntil the full tumor resection was completed.There are a few previous reports of SFV conduits in

oncologic resections. Hagino et al. [41] reported the useof the SFV in seven patients. Three of these vascularresections were for tumors, including two superior venacava resections and one reconstruction of the internaljugular vein in a patient undergoing bilateral radical neckdissections. There were no early or late graft occlusions,venous thromboembolism, and minimal donor limbmorbidity. Leggon et al. [42] report a series where16 patients who underwent limb-sparing surgery withvascular reconstruction. Two of the patients had recon-structions using the SFV, while the majority of patientshad saphenous vein grafts. Unfortunately it is notpossible to compare outcomes of patients who had SFVreconstructions to patients who had other reconstructions.

For the entire group of 16 patients, graft thrombosisoccurred in 4 (25%).The results of the current study compare favorably

with other reports of tumor resection with involvement ofmajor vascular structures. Schwarzbach et al. [28] reporta series of 21 patients who underwent limb-sparingsurgery for tumors involving major vascular structures.The long-term patency after a median follow-up of34 months for 20 arterial reconstructions (12 prostheticgrafts, 8 GSV grafts) was only 58.3% and the long-termpatency of 12 venous reconstructions (10 prostheticgrafts, 2 GSV grafts) was only 54.9%. In addition, therewas more serious morbidity and one-third of patientsrequired re-operation, including four patients who hadgraft infections (three prosthetic, one GSV graft).Another series of limb-sparing surgery with vascularreconstruction (using prosthetic grafts or GSV grafts)demonstrated a higher incidence of severe limb edema(87%) and DVT (26%) than in the present series [43]. TheSFV was not used as a conduit in either of these series.The limitations of this study include the small series

size, and the retrospective analysis that does not allowcomparison to other reconstruction techniques. It is notpossible to make comparisons to a concurrent orhistorical control group, and comparison to patientswho did not require vascular reconstruction are hamperedby inherent differences in tumor location and biology.However, the favorable results of our series of majoroncologic resections with vascular reconstruction usingSFV supports others who have shown that modernvascular techniques allow resection of tumors involvingmajor vascular structures with acceptable early and latemorbidity and mortality and with favorable long-termoncologic outcomes [5,9]. Karakousis et al. [9] report aseries of 21 patients who underwent major vascularreconstruction in the setting of limb-sparing surgery forsoft tissue sarcoma. They found an estimated 5-yearsurvival of 63%, which parallels that of patientswith sarcomas not requiring vascular resection. TableIII shows the results of other series reporting outcomesfollowing resections of extremity malignancies requiringmajor vascular resection and reconstruction.Most centers describe a 5–10% amputation rate for

primary extremity sarcomas [16,43,44]. Further, marginpositivity is common following the resection of retro-peritoneal sarcomas; at times due to the proximity ofmajor vascular structures. We speculate that vascularreconstruction with the SFV is an underutilized optionthat may improve limb salvage rates as well as the abilityto obtain negative microscopic margins. Involvement ofmajor vascular structures should no longer be a contra-indication to tumor resection or limb salvage as manypatients will have a favorable long-term oncologicoutcome.


156 McKay et al.


TA

BL

EII

I.R

esu

lts

of

Oth

erS

urg

ica

lS

erie

sR

epo

rtin

gR

esec

tio

no

fE

xtr

emit

yM

ali

gn

an

cies

Req

uir

ing

Ma

jor

Va

scu

lar

Res

ecti

on

an

dR

eco

nst

ruct

ion

Author

Year

No.

patients

Tumor

Arterial

reconstruction

Arterial

occlusions

Venous

reconstruction

Venous

occlusions

Follow-

up

Local

recurrence

Distant

mets

Disease

free

survivala

Overall

survivala

Fortner

1977

76Sarcoma

2Dacron

0/4

2SVG

0/3

2/7

2/7

57%

86%

1Squam

ousCell

2SVG

1Axillary

Vein

3Ligated

3Ligated

Imparato

1978

13

13Sarcoma

13SVG

1/13

3SVG

0/3

46mos.

2/13

5/13

46%

62%

Karakousis

1996

21

21Sarcoma

17PTFE

—2PTFE

—49mos.

3/21

8/21

63%

(5-Y

r)

4VeinGraft

1VeinGraft

5Ligated

Kaw

ai1996

87Sarcoma

4Dacron

3/8

5PTFE

6/7

43mos.

0/8

2/8

75%

100%

1Desmoid

4SVG

2SVG

1Ligated

Koperna

1996

14

14Sarcoma

7SVG

0/7

1Dacron

0/1

55mos.

06

57%

(5-Y

r)71%

4PTFE

2/4

8SVG

1/8

Reix

1998

77Sarcoma

——

4Ligated

—36mos.

04

43%

43%

2VeinPatch

0/2

Hohenberger

1999

20

20Sarcoma

8PTFE

3/20

4PTFE

3/11

411

35%

48mos

Median

11SVG

6VeinGraft

1Primary

Repair

1Primary

Bonardelli

2000

77Sarcoma

2SVG

1/2

5SVG

0/5

33mos.

02

71%

71%

2PTFE

0/2

Leggon

2001

16

15Sarcoma

1Dacron

0/1

7VeinGraft*

0/7

56mos.

250%

63%

1Basal

Cell

12VeinGraft

4/12

2Primary

Repair

0/2

Nishinari

2004

20

12Sarcoma

2PTFE

0/3

3PTFE

2/3

6–55

mos.

47

40%

60%

2Adenocarcinoma

3Dacron

0/2

2Dacron

2/2

2Melanoma

13SVG

0/13

8SVG

0/8

1Germ

Cell

1Squam

ousCell

1Basal

cell

Schwarzbach

2005

21

21Sarcoma

8SVG

3/8

2SVG

5/12

34mos.

39

38%

(5-Y

r)52%

(5-Y

r)

10PTFE

4/10

10PTFE

2Dacron

0/2

SVG

–saphenousveingraft;PTFE–expanded

polytrafluoroethylene.

aBoth

disease-freeandoverallsurvival

figuresrepresenttheactual

number

ofsurvivors

over

thefollow-upperiodofthestudiesunless

otherwiseindicated.


CONCLUSION

Resection of tumors involving critical vascular struc-tures is feasible. The SFV represents a versatile option foruse as a conduit when concomitant reconstruction ofarterial and venous structures is required, and is asso-ciated with minimal morbidity and excellent long-termpatency rates. Vascular resection and reconstruction withthe SFV represents another available technique to providelimb-sparing surgery in patients traditionally offered onlyamputation, while providing favorable oncologic out-comes.

ACKNOWLEDGMENTS

This material was presented as an abstract at theSociety of Surgical Oncology’s 60th Annual CancerSymposium, March 15–18, 2007, in Washington, DC.

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vascular reconstruction with the superficial femoral vein following major oncologic resection

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