Primary Leiomyosarcoma of the Inferior Vena Cava and Interposition of a Bovine Pericardial Graft

Abstract Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare disease with fewer than 220 cases reported in the literature. Symptoms usually develop late in the course of the disease delaying the diagnosis and worsening the prognosis. Curative treatment consists of total surgical resection of the tumour with interposition grafting for the missing portion of the IVC. The reported 5 year survival rate ranges from 37 to 53%. We report a case of a 58-year-old female with primary leiomyosarcoma of the juxtarenal IVC diagnosed incidentally on abdominal ultrasound. After further investigation by computerised tomography angiography (CTA), the tumour was removed completely with clear surgical margins. Bovine pericardium was used as an interposition graft for the resected portion of IVC. Some advantages of using this material for venous bypass include its versatile diameter options, malleability, minimal needle hole ooze and less potential for infection in comparison to synthetic grafts [Vasc. Endovasc. Surg. 37 (2003) 225]. Further research is needed regarding the patency rate, late infection and overall success. We believe a high index of suspicion is crucial for the early diagnosis of this disease. An aggressive surgical approach is necessary for optimal survival.