Novel Management of Complicated Renal Artery Aneurysm: Laparoscopic Nephrectomy and Ex-Vivo

Background and Purpose: Renal artery aneurysm (RAA) is an infrequently seen disease entity but one with the potential for significant morbidity and mortality. Complications related to RAA include pain, hematuria, hypertension, and, rarely, rupture. Management is often based on symptomatology or, if symptoms are not present, the potential for rupture with increased size. Treatment options include observation, endovascular methods, or open surgical approaches, including aneurysm repair or nephrectomy. Complex cases often preclude endovascular approaches. We report our initial experience with laparoscopic nephrectomy, ex vivo back-table repair of the aneurysm, and iliac fossa autotransplant in cases of complex RAA. Patients and Methods: Two patients underwent laparoscopic nephrectomy with RAA repair and heterotopic autotransplant from May 2006 to November 2008. Etiology of the RAA was atherosclerosis in one patient and idiopathic in the second. Laparoscopic nephrectomy and back-table arterial reconstruction was performed, including aneurysmectomy and ostial closure. Patient 2 needed a gonadal vein graft for arterial reconstruction. Both patients had autotransplant into the right iliac fossa. Results: Both patients were women. Mean age was 52.5 years (range 39–66 yrs). Mean operative blood loss was 550 mL (range 350–750 mL). Mean length of stay was 5.5 days (range 5–6 d). Mean discharge creatinine level was 0.8 mg/dL (range 0.5–1.1 mg/dL). No perioperative complications were reported. At last follow-up, all patients are alive with functioning autotransplant and no evidence of functional impairment. Conclusion: Management of complex RAA with laparoscopic nephrectomy, extracorporeal repair, and autotransplant is a feasible and successful method with minimal morbidity

Leiomyosarcoma of intravascular origin - a rare tumor entity: clinical pathological study of twelve cases

<p>Abstract</p> <p>Background</p> <p>Leiomysarcoma of intravascular origin is an exceedingly rare entity of malignant soft tissue tumors. They are most frequently encountered in the retroperitoneum arising from the inferior vena cava and are scarcely found to arise from vessels of the extremities. These tumors were analysed with particular reference to treatment outcome and prognosis. The aim of this article is to broaden the knowledge of the clinical course of this rare malignancy.</p> <p>Method</p> <p>During 2000 and 2009 twelve patients were identified with an intravascular origin of a leiomyosarcoma. Details regarding the clinical course, follow-up and outcome were assessed with focus on patient survival, tumor relapse and metastases and treatment outcome. 3 year survival probability was calculated using Kaplan-Meier method.</p> <p>Results</p> <p>Vascular leiomyosarcomas accounted for 0.7% of all malignant soft tissue tumors treated at our soft tissue sarcoma reference center. The mean follow up period was 38 months. Tumor relapse was encountered in six patients. 6 patients developed metastatic disease. The three year survival was 57%.</p> <p>Conclusion</p> <p>Vascular leiomysarcoma is a rare but aggressive tumor entity with a high rate of local recurrence and metastasis.</p