A Physician Made Biological Stent Graft for the Replacement of a Left Renal Vein Leiomyosarcoma

Primary venous leiomyosarcoma is an unusual and aggressive tumour; its presentation on the renal vein is rare. This case study presents a 50 year old man with severe obesity who was incidentally diagnosed with a left renal vein leiomyosarcoma during pre-operative evaluations for a cholecystectomy. Following a multidisciplinary discussion with oncology and vascular surgeons, the patient underwent complete resection of the left renal vein along with the mass.

This article proposes an innovative surgical technique for the reconstruction of the left renal vein in case of a left renal vein leiomyosarcoma. Reconstruction was achieved using a physician made biological stent graft, employing a nitinol bare stent wrapped in a pericardial patch. The video provides a step by step explanation of the procedure. Isolation and the surgical technique for the reconstruction of the left renal vein following en bloc resection of the leiomyosarcoma are shown, followed by reconstruction of the vein using a nitinol stent covered with bovine pericardium. Several precautions were adopted to minimise the risk of intestinal fistula, including heterotopic graft re-implantation and omentoplasty.

Complete surgical excision remains the cornerstone of vein sarcoma treatment and offers the best chance for disease control. The literature has only reported en bloc resection of renal vein sarcomas with nephrectomy. This case report presents an innovative surgical technique for left renal vein replacement, showing a potential alternative in the management of this rare condition in order to preserve the vein.