The Use of Extracorporeal Circulation to Facilitate the Resection of a Large Retroperitoneal Sarcoma With Major Vessel Involvement: A Single-Center Review of 20 Cases.

OBJECTIVE: To describe the introduction of extracorporeal corporeal oxygenation (ECMO) to facilitate the surgical resection of large retroperitoneal sarcomas involving major vessels and to report preliminary outcomes. DESIGN: A case series. SETTING: At a tertiary university hospital and state sarcoma center. PARTICIPANTS: Patients undergoing retroperitoneal sarcoma resection requiring inferior vena cava (IVC) reconstruction between June 2018 and March 2022. INTERVENTION: ECMO for retroperitoneal tumor resection requiring IVC reconstruction. MEASUREMENTS AND MAIN RESULTS: A total of 20 patients underwent ECMO-assisted retroperitoneal sarcoma resection and IVC reconstruction. The median age was 60.5 years (IQR 48-69); 15 women and 5 men. The median procedure and ECMO durations were 10.8 hours (IQR 8.5-12.4 hours) and 2.2 hours (IQR 62-218 minutes), respectively. The median intensive care unit and hospital lengths of stay were 4 days (IQR 3-5 days) and 21 days (IQR 14-31 days), respectively. All 20 patients received packed cell transfusions (median 8 per patient [IQR 4-14]); 11 patients required fresh frozen plasma, 6 required platelets, and 11 required fibrinogen supplementation. One patient required recombinant activated factor VII. Sixteen patients experienced acute kidney injury, with 12 patients progressing to chronic kidney disease. Three patients were required to return to the operating room within 7 days, with no returns within the first 24 hours. There was no in-hospital or 30-day mortality. Survival at 3 years was 84%. CONCLUSIONS: ECMO for resecting large retroperitoneal tumor resection was introduced successfully and facilitated satisfactory outcomes for many patients who might otherwise have been considered too high risk.

Intimal windsock following type A aortic dissection: An intussusception of severe implications.

BACKGROUND: A patient has presented with type A aortic dissection and computed tomography aortogram revealed proximal and distal aorta intimointimal intussusception. MATERIAL & METHODS: The patient has undergone successful aortic root replacement surgery and on the way to his recovery, he developed inferolateral myocardial infarction with the troponin I leak. RESULTS: The coronary angiogram showed a small contrast leak around the left button with no luminal compromise. CONCLUSION: An intravascular ultrasound played a major part in the diagnosis of left main coronary artery compression due to the intramural hematoma. A drug-eluting stent was deployed to relieve the compression and to support the dissected layers of the coronary artery.