Chapter 194 - Vascular tumors Flashcards
Salm classification of primary arotic tumors
1) polypoid/intraluminal
2) intimal
3) adventitial
Wright classificadtion of aortic tumor
1) intimal tumor (polypoid, intraluminal)
2) mural tumor (adventitial
Characteristic of polypoid/intraluminal tumors
1) attach to intima
2) grow intraluminally
3) propensity to embolize
Characteristic of intimal tumors
1) infiltrative
2) grow along endothelial surface
3) can occlude large branch vessels
Adventitial/mural tumor characteristics
1) grow beyond the confines of the aorta
2) invade adjacent structures
Tumors of the vena cava
TABLE 194.1
Most common primary IVC tumour
Venous leiomyosarcoma
polypoid or nodular more often than arterial counterpart grows intraluminally extends through adventitia can invade adjacent structures
Most common malignancy to invade infrarenal IVC
Retroperitoneal sarcoma
Most common malignancy to exhibit intraluminal tumor thrombus
Renal cell carcinoma
tumor thrombus 4-15% of cases
Epidemiology of primary venous leiomyosarcoma
1) more in women
2) age 50-60
3) 50% mets at diagnosis
Symptoms of primary venous leiomyosarcoma
1) cardiac
2) hepatic obstruction (Budd Chiari syndrome)
3) renal vein outflow obstruction
4) invasion of retroperitoneal muscle/nerve
Budd Chiari triad
1) abdominal pain
2) ascites
3) liver enlargement
Special considerations in tumor resection and arterial reconstruction conduit
Can use SFA
then replace SFA with prosthetic keeping the two field separate
Calculating the diameter of patch needed to repair IVC defect
pi(3) x vein diameter normal x % wall to be replaced
Graft choice for IVC replacement
externally reinforced ringed PTFE up to 20 mm
