Limb-preserving vascular surgery for malignant tumors of the lower extremity

Monobloc soft-part resections have been carried out with excision of segments of the illac and femoral vessels in seven patients with cancer in the lower extremity. Amputation would have been necessary otherwise. Ischemic loss of the extremity did not occur. In four of the earlier patients, vascular reconstruction was not performed, and postoperative lymphedema was a major complication. In the recently treated three patients, complete reconstitution of the circulation by simultaneous arterial and venous grafting permitted smooth postoperative recovery and absence of notable edema. Creation of a distal arteriovenous fistula appears essential to maintain venous patency. Six of the seven patients are alive at six months, 1, 3, 4, 7, and 18 years, respectively. One patient died of pulmonary metastases at three years after operation. Two patients developed local recurrences requiring limb disarticulation, both in the earlier group in which excision and grafting of both artery and vein was not done. It is concluded that excision and simultaneous reconstruction of major blood vessels can extend the scope of soft-part resections for cancer of the extremities, offering opportunities for preservation of limbs that would otherwise require amputation for control of disease.