[Leiomyosarcoma of the great veins: a case involving the left iliac vein extending to the inferior vena cava]. / Léiomyosarcome des grosses veines: un cas de LMS de la veine iliaque gauche s'étendant a la veine cava inférieure.

Large veins LMS is a rare slow growing malignant tumor originating from smooth muscle cells of the media. The authors report a case of LMS of the left common iliac vein propagating to the Inferior Vena Cava that presented with a left femoral-iliac deep thrombophlebitis. CT scan showed an uneven solid mass approximately 5 cm large within the left side of the pelvis. The mass displaced the left iliac artery and compressed the left iliac vein without a significant cleavage surface between the mass itself and the vascular structures. Location was next to the spine, medially and anteriorily to the psoas muscle. A thrombosis could be noticed within the distal segment of the inferior Vena Cava and within the proximal segment of the left iliac vein. US scan with fine needle biopsy of the mass didn't yield significant information. At surgical exploration a neoplastic mass involving and blocking the left iliac vein was found. Veinotomy performed on the iliac vein and on the distal segment of the Inferior Vena Cava but without infiltration of the vein walls. Surgical treatment consisted of asportation of the neoplastic mass, resection of the left iliac vein and thrombectomy of the Inferior Vena Cava. Histologic examination of the operated specimen revealed a mixoid LMS with vascular origin without involvement of the surrounding lymph nodes. Absence of clinical and radiological signs of relapse eight months after surgery makes further surgical and complementary (drug- and radiotherapy) treatments currently unnecessary.

Surgical management of intraluminal carotid thrombi.

The most suitable treatment for intraluminal carotid thrombi remains still a much debated question. Some authors have reported a lower morbidity in patients treated with anticoagulant or antiplatelet therapy; on the other side, urgent or delayed surgery is burdened with a high risk of perioperative stroke. Over 11 years (october 1981-november 1992) 602 surgical revascularizations on epi-aortic vessels have been performed at Vascular Surgery Unit of Udine Regional Hospital. Only 2 cases of intraluminal carotid thrombi were observed: both fulfilled the angiographic requirements for endovasal filling defect, surrounded by contrast medium, adherent to posterior wall and extending to distal internal carotid artery. First patient suffered a TIA 20 days before surgery, the second one a previous major stroke contralateral to the thrombus. The former was given preoperatively a medical anticoagulant treatment (warfarin). At operation we discovered a nearly complete resolution of the thrombus: only its adherent base was still present. Therefore we performed a routine endarterectomy and a PTFE patch angioplasty. The latter case reported had no preliminary medical treatment; a thrombus extending from carotid bulbus to external and internal carotid was detected and then removed without any distal embolization. Arteriotomy was closed by Dacron Velour patch angioplasty. No perioperative stroke occurred in both cases: our second patient showed a partial resolution of his motility deficit. According to our limited experience, delayed surgical treatment of intraluminal carotid thrombi seems not to be affected with higher risk of perioperative stroke than prophylactic carotid endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Complications of vascular prosthesis]. / Complicanze delle protesi vascolari.

The main complications deriving from the use of vascular prostheses in the surgical reconstruction of the arteries are thrombosis, infection and the appearance of pseudoaneurysms. Among 233 aorto-femoral b.p., prosthetic thrombosis occurred in 45 patients creating the need for 66 reoperations, 19 early and 47 tardive. In 387 aorto-iliac reconstructions, infection arose early in 11 cases, tardively in 6. Out of 1118 vascular reconstructions there were also 28 pseudoaneurysms (2.5%). After remarks on the aetiopathogenesis of such complications, methods that can be used to prevent them are discussed and personal results of treatment are presented.