[Considerations about the endovascular treatment of infrarenal aortic aneurysms]

The introduction of the endovascular repair of aortic aneurysm (EVAR) in the clinical practice by Parodi was a milestone in the development of aortic surgery. This minimal invasive procedure promised a significant lower postoperative mortality and complications rate. Despite numerous controversies, the endovascular technique was wide accepted and fast implemented in the clinical practice. But the first prospective randomized trials showed that the benefit of the patients was limited and this innovative approach leads to particular postoperative problems. Due to a continuous improvement of the endovascular devices and increasing experience in endovascular treatment a lot of early problems have been resolved. The new generation of endografts makes possible the endovascular approach of aneurysm with shorter or angulated proximal neck. However, the anatomical suitability is still the most important limited factor of the endovascular treatment. An accurate analysis of suitability, the proper choice of the device and correct implantation allows good postoperative results. The significance of specific complications must be recognized in order to make the right surgical decision.

Successful surgical management of a recurrent leiomyosarcoma of the inferior vena cava

The leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour of the venous system. The recurrence of the tumour after previous initial surgical resection is common and occurs in more than half of the patients. Surgical resection of a local recurrence is poorly described in the literature and the available data are restricted to a small number of cases. We report the case of a 62 year old woman, who was referred to our vascular surgical unit for recurrence of a leiomyosarcoma of the inferior vena cava, 35 months after diagnosis and initial surgical treatment. We performed an extensive local resection and circumferencial replacement of the IVC. 18 months after the second operation and adjuvant radiotherapy, the patient is in a very good physical condition and CT-scans show no evidence of tumour recurrence.