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Multimodal endovascular palliation for femoral arterial blowout in the setting of metastatic vulvar carcinoma.

Significance  Statement

Vascular blowout syndrome is a well-recognized entity in the setting of adjacent and/or metastatic neoplastic processes. This has been most commonly described in the carotid circulation in the setting of advanced-stage head and neck malignancies. Neoplasms of the female genital tract with metastatic components affecting the iliofemoral circulation with threatened or impending rupture have rarely been described in the literature and approaches have been variable with inconsistent outcomes.  Herein, we report a unique case of metastatic vulvar-squamous cell carcinoma involving the left inguinal lymph nodes causing threatened blowout of the left femoral arterial bifurcation, recurrent bouts of intractable hemorrhage, and threatened acute limb ischemia.  Superselective bland tumor embolization and covered stent exclusion was performed as a safe and effective palliative technique in a minimally invasive fashion. Awareness of vascular blowout syndrome as a life-threatening condition associated with advanced stage malignancies and the availability of durable and effective endovascular techniques is important for palliation and improvement of quality of life in this fragile patient population.

Figure Legend: Fungating metastatic neoplastic mass in the left inguinal region. B.  CT scan reveals encasement and impingement of the left femoral arterial bifurcation with multiple bouts of hemorrhage requiring hospitalization and transfusion.  C.  Diagnostic angiography before treatment reveals hypervascularity of the metastatic mass with impingement upon the common femoral, superficial femoral, and profunda femoral arteries.  D.  Following superselective bland embolization of the tumor and covered stent revascularization of the left femoral circulation, arterial integrity is restored and the arteries are protected from any further tumor erosion.

 

Multimodal Endovascular Palliation for Femoral Arterial Blowout in the Setting of Metastatic Vulvar Carcinoma. Global Medical Discovery

 

 

 

 

 

 

 

 

 

 

 

 

 

Journal Reference

Nassiri N1, Kogan S2, Gibbon DG3, Graham A2. Ann Vasc Surg. 2015 Jan;29(1):127.e11-5.

Show Affiliations

1Division of Vascular Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: [email protected]

2Division of Vascular Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.and

3Department of Gynecologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.

 

Abstract

BACKGROUND:

Vascular blowout syndrome is a well-known, life-threatening condition complicating advanced-stage head and neck malignancies but has rarely been reported in the gynecologic oncology realm in association with the femoral circulation. A 50-year-old woman with metastaticvulvar squamous cell carcinoma presented with left threatened femoral arterial blowout, secondary to an exophytic neoplastic mass originating from the left inguinal lymph nodes.

METHODS:

Bland embolization of the tumor as well as 3 vessel covered stent revascularization  was successfully performed with excellent tumor devascularization and reinstitution of arterial integrity.

RESULTS:

Successful devascularization of the tumor, with no non-target embolization was achieved, with excellent apposition and deployment of 3 covered stents in the femoral artery bifurcation.

CONCLUSION:

We present a unique case of threatened femoral artery blowout syndrome in the setting of metastatic vulvar carcinoma requiring various  endovascular  techniques for palliation. These endovascular techniques can be invaluable in minimally invasive palliation of advanced stage neoplasms abutting the iliofemoral circulation.

Copyright © 2015 Elsevier Inc. All rights reserved.

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