Vascular segmental exclusion for recurrent vulvar squamous cell carcinoma invading the femoral vessels

Abstract

A 55-year-old woman presented with a recurrent left inguinal necrotic mass caused by locally invasive vulvar carcinoma. Computed tomography of the abdomen pelvis showed compression of the femoral vein and superficial femoral artery. The patient underwent a left axillary to popliteal artery bypass with left superficial femoral artery embolization in preparation for possible wide resection. Subsequent resection was aborted because of extensive local invasion and rapid spread. Three-month follow-up revealed a patent graft. The patient died after 4 months from progression of oncologic disease and an unresectable tumor in the groin that eroded through the blood vessels without bleeding or lower limb ischemia.

Keywords: Axillopopliteal bypass; Gynecologic malignancy; Oncovascular surgery.

Fig 1

Preoperative wound and imaging. (A) Left groin infected and necrotic wound at presentation. (B) Preoperative positron emission tomography scan at the level of the left groin mass. (C) Axial cross-sections from the preoperative computed tomography (CT) angiography at the level of the (C) common femoral artery (CFA), (D) left groin necrotic mass, (E) superficial femoral artery (SFA) below the level of the mass showing compression of the left SFA.

Fig 2

Lateral exposure of the left popliteal artery.

Fig 3

Intraoperative angiogram showing compression of the left superficial femoral artery (SFA) by the mass (A) left common femoral artery (CFA) and SFA post-coil embolization and plug (B), proximal anastomosis at the axillary artery (C), and distal anastomosis at the popliteal artery (D).

Fig 4

Postoperative left groin embolization coil erosion. (A) Three-month postoperative computed tomography (CT) angiography showing erosion of the embolization coil at the level of necrotic mass. (B) Three-month postoperative left groin with embolization coils eroded through the femoral artery without hemorrhage.