Surgical treatment of tumors involving the inferior vena cava. Personal experience

J Cardiovasc Surg (Torino). 2008 Jun;49(3):323-8.


Aim: Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor that frequently produces non-specific symptoms. Surgical treatment is complex. In this review of our experience, we highlight replacement modalities of the vena cava or other vessels after complete tumor resection.

Methods: During the last 20 years, we treated 12 patients (6 women and 6 men; age range, 38-72 years) with IVC leiomyosarcoma, all apparently free of distant metastases. Tumor location, graft patency, long-term survival and tumor recurrence were recorded. The tumor arose from the IVC in 8 patients; in 2 cases the intracaval mass reached the right atrium; in 4 patients the tumor arose from the femoroiliac axis. Surgical approach was by sternolaparotomy in 5 cases and by median xyphopubic access in 7. Extracorporeal circulation (ECC) was needed in 2 cases. All tumors were removed by en bloc resection. The IVC was directly sutured in 2 patients and patched in 4; no reconstruction was necessary in 2 patients; the IVC was replaced in the remaining cases. Four patients had an additional arteriovenous fistula. One patient underwent bifurcated Dacron graft replacement of the aortic carrefour involved by tumor.

Results: Two patients died postoperatively. One patient developed late stenosis of the polytetrafluoroethylene (PTFE) graft, which was treated by stenting. The mean follow-up period was 35 months. The 4-year survival rate was 51% and survival free of recurrence was 63%.

Conclusion: Leiomyosarcoma of the IVC is an uncommon tumor that produces non-specific symptoms. In the absence of distant malignancy, an aggressive approach can obtain late survival free of recurrence.

MeSH terms

  • Adult
  • Aged
  • Blood Vessel Prosthesis Implantation / methods
  • Female
  • Humans
  • Leiomyosarcoma / diagnostic imaging
  • Leiomyosarcoma / surgery*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Polytetrafluoroethylene
  • Stents
  • Survival Rate
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Neoplasms / diagnostic imaging
  • Vascular Neoplasms / surgery*
  • Vascular Patency
  • Vena Cava, Inferior*


  • Polytetrafluoroethylene