Vascular surgery strategy to preserve function in lower limbs sarcoma resection.: An oncovascular approach

Objective: All strategy should be adopted to preserve limb function in case of limbs bone sarcoma. The aim of the study is to share our experience on intervention, results and complications of the performed vascular surgery and reconstructive procedures in patients with lower limb sarcoma. Methods: From 2011 to 2023, among 32 patients with musculoskeletal neoplasms with a mean age of 44 years (14-67 years), 28 cases (87.5%) underwent revascularization. The study included a biopsy of the lesion, ultrasonography and computed tomography angiography to evaluate of the vascular anatomy, neoplasia extension and postoperative course. The follow-up was 20.1 months. Results: The reconstruction of the vessels has been implemented in 14/28 (50%) mainly using the autologous saphenous contralateral vein. The use of the prostheses (PTFE and Dacron K) was performed in the other 50% of cases. In five cases (15.6%), the patients had lower limb edema. After vascular surgery, a venous patency restored in 26/32 (80%) and arterial - 100%. No mortality was noted at 30 days. Two patients underwent vacuum assisted closure therapy. In 14 patients perioperative chemotherapy or radiotherapy was performed. Conclusions: Major vessel involvement during cancer surgery may be considered also in musculoskeletal tumors. The vascular competence in a multidisciplinary approach, plans the exact surgical view through the avascular plane far from neoplasm and may prevent or minimize the bleeding complications, assuring definitive result of the resection.