PubMed · 8337521
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T Ohhashi. 1993. [Peripheral circulation and microcirculation in lower extremities].. https://pubmed.ncbi.nlm.nih.gov/8337521/
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Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a new case of primary leiomyosarcoma of the inter-renal vena cava is reported. Surgical treatment consisted of excision of the vena cava on top of the renal arteries allowing radical resection. Reconstruction was original. The distal vena cava was sectioned and ligated just above the bifurcation and the free segment used to replace the excised part. In this the right venal vein was directly implanted. The left renal vein was reimplanted in the translocated segment via a venous (femoral vein) graft. Ligation of the distal vena cava was haemodynamically well-tolerated and the patient was free of symptoms at one year after operation. Control angiogram showed patency of the venous reconstruction. Early diagnosis is essential to improve patient survival, since it allows better radical resection, which is the only way of preventing the development of metastases.
Both direct and indirect duplex sonography (DS) permit the diagnosis of significant renal artery stenosis. The validity of direct DS, based on the detection of increases in the blood velocity in stenotic arteries, is affected by numerous factors (inappropriate examination conditions, presence of vascular variants). In the technique of indirect DS, renal artery stenosis is detected via changes in the hemodynamics of intrarenal vessels ('tardus-et-parvus' phenomenon). Various evaluation parameters (signal shape, acceleration time, acceleration index, resistance index, pulsatility index) have proven useful for signal analysis. The intraindividual comparison of the two sides is an important instrument of stenosis detection in indirect DS. In clinically selected populations of hypertensive patients, DS may be used as a method of stenosis screening. DS has proven its practical value as a follow-up method after angioplastic intervention. It remains to be shown in future investigations whether "functional' classification of the degree of stenosis on the basis of Doppler sonographic findings is feasible.
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