Cross-Femoral Venous By-Pass (Palma’s Procedure) to Relieve Venous Hypertension Due to Retroperitoneal Leiomyosarcoma: A Case Report

Abstract

Retroperitoneal leiomyosarcoma arising in, or involving, the inferior vena cava or the iliac vein are infrequent tumours. They are usually treated by “en-block” surgery. Venous reconstruction is usually not needed, since collateral circulation can adequately offset the main vessel flow. However, in rare cases, collateral circulation may be insufficient. The authors report a case of leiomyosarcoma infiltrating the left iliac vein. One week after radical resection surgery, the patient developed left leg compartmental syndrome due to venous hypertension.

The patient was successfully treated by thrombectomy of the left femoral vein and cross-femoral venous bypass (Palma’s Procedure) by means of an 8 mm diameter polytetrafluoroethylene (PTFE) prosthesis. To improve the flow inside the graft, an arterio-venous fistula (AVF) was performed. The choice of a prosthetic conduit, its diameter, and the AVF are discussed.

Key Words:

• Iliac vein
• retroperitoneal neoplasms
• post-thrombotic syndrome
• venous hypertension
• Da Palma procedure.

Additional information

Notes on contributors

S. Lentini

S. Lentini, M.D., F.E.S.C. Department of Cardiovascular Surgery Policlinico G Martino Università di Messina Viale Gazzi 98100 Messina, Italy Tel.: +(39) 090 2217081 Fax: +(39) 090 2217086 E-mail: [email protected]