Vascular reconstruction for limb salvage in soft tissue sarcomas

Ten patients with soft-tissue sarcomas of the lower extremity had involvement of major vessels, which were resected along with the surrounding tumor and muscles and replaced with vascular grafts. One of these patients had metastatic, unresectable disease and was operated on for palliation while three had resectable metastases and were included in the "curative" resection group. The resection involved the iliac vessels in three patients, the femoral vessels in six patients and the posterior tibial vessels in one patient. Ten arterial grafts were used--nine of them synthetic and one a reversed saphenous graft. Of six venous synthetic grafts, two remained patent for 3 and 4 months, while four clotted in the immediate postoperative period. Two of the patients have moderate swelling if they stand for a prolonged time, which is well controlled with elastic support. Of two infections, one involved the arterial graft and necessitated amputation. Adjuvant radiation was used in three patients and adjuvant chemotherapy in five patients. Three patients underwent chemotherapy for measurable metastatic disease. Of eight patients who underwent curative resection and successful arterial reconstruction, none has relapsed locally in a follow-up period ranging from 12 to 61 months (mean: 24.8 months). Six of the nine patients who underwent curative resection remain alive and well at 12 to 61 months (mean: 27 months). Limb salvage for sarcomas of the extremities, which involves major vessel resection and reconstruction, is an effective method of treatment and is preferable to amputation.