A 74-year-old man with an intra-abdominal leiomyosarcoma presented with bilateral lower-extremity edema and pain for 4 weeks (A). The edema and pain became so severe that it significantly limited his functional status, making it difficult to walk. The patient was not a candidate for surgical resection due to metastatic disease. Although currently starting neoadjuvant chemotherapy, this was halted given his declining functional status. Computed tomography scan of the abdomen and pelvis showed near complete compression of the inferior vena cava (IVC) due to the large mass (B). Moreover, the patient developed deep vein thrombosis in the right calf, due to venous stasis from IVC compression. He was referred to Interventional Radiology for potential IVC stent placement. Venography showed narrowing of the suprarenal IVC up to the confluence of the right atrium, but without stasis, and minimal collateral opacification (C). Intravascular ultrasound (IVUS) study better showed that the diameter of the IVC was severely compressed (95%) over 13 cm (D), which informed the selection of a 20 mm × 15 cm Abre venous stent (Medtronic) and landing zone at the junction of the right atrium. Poststent venography demonstrated restored brisk flow through the IVC and improved luminal caliber on IVUS study. The patient's edema resolved within 12 hours, and he was able to walk without pain or swelling the following day. At 6-month follow-up, the patient is doing well clinically, having resumed all his daily activities, ambulating without issue, and has tolerated chemotherapy with excellent response and persistent improved IVC patency. The patient agreed to the publication of their case details and images.
Leiomyosarcoma is a rare malignant smooth muscle tumor, which occurs intra-abdominally or in the retroperitoneum 10% to 20% of the time.1,2 In patients with IVC compression, stent placement is a palliative management option that may improve quality of life.1,3 However, despite reported success rates of 78% to 100%, IVC stent placement is generally reserved for patients with severe symptoms of IVC syndrome because the procedure carries risk of stent migration and vessel perforation.1,4 IVUS study minimizes the risk of these complications by precisely quantifying the location and severity of obstruction and, consequently, is advantageous over conventional venography in stent sizing.5
Funding
None.
Disclosures
None.
Footnotes
The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
Additional material for this article may be found online at www.jvsvenous.org.
Appendix
Additional material for this article may be found online at www.jvsvenous.org.
Appendix (online only)
Cover image.
References
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