Introduction: Leiomyosarcomas arising from the inferior vena cava (IVCL) are rare tumors that often present with nonspecific symptoms. Gold-standard treatment includes complete resection of the lesion with reconstitution of venous return. Herein, we present a video of an IVCL that required IVC and bilateral iliac vein reconstruction.
Case Report: A 77 year old male presented with right lower extremity swelling from a newly-discovered deep vein thrombosis. Abdominal imaging revealed an 8.3 cm retroperitoneal mass abutting the right common iliac vein (CIV) and distal IVC. After a staging work-up revealed no distant disease, he was taken to the operating room for resection of the retroperitoneal sarcoma with right iliac vein and IVC involvement requiring right iliac vein and vena cava reconstruction with a 16mm ringed polytetrafluoroethylene (PTFE) graft and a juxtaposed left common iliac vein reconstruction with 16 mm ringed PTFE graft. Pathologic analysis revealed an 8.8 cm grade 3 leiomyosarcoma arising from the inferior vena cava and right iliac vein confluence with no nodal involvement (stage IIIA). He was discharged from the hospital on postoperative day 11 to a rehabilitation facility. There is no plan for adjuvant radiation therapy or chemotherapy at this time.
Discussion: Radical en bloc surgical resection is the gold-standard treatment for IVCL. Complex vascular reconstruction techniques may be necessary to reconstitute venous return. With adequate margins, IVCL requires no further adjuvant treatment.