Reconstruction of the iliocaval venous segment in tumor surgery

The revascularization of the iliocaval segment is one of the most exciting and challenging treatments of the vascular surgery. Particularly promising is the reconstruction in case of renal cell carcinoma or adrenal neoplasma with tumor thrombus extension into the inferior vena cava. In these cases an improvement of the quality of life and also an increased life expectancy can be achieved. Experiences with replacement of the inferior vena cava in tumor are very small and the follow-up, if reported, rarely exceeds 1 year due to the underlying malignant disease. The reconstruction is indicated only in a selected group of patients. In tumorous stenosis or obstruction of pelvic veins, thrombectomy, venous dilatations with subsequent stent-implantation, carries a minor operative risk and offers the opportunity to attain a better quality of life. The Cross-Over-Bypass is indicated in cases of unilateral occlusion due to primary or metastatic neoplasm with severely impaired peripheral microcirculation and impending phlegmasia coerulea dolens. Autologous Cross-Pubic-Bypasses, by anteposition of the external iliac vein on the affected side or by a graft from the contralateral healthy superficial femoral vein, offer a useful alternative to the classical PALMA operation or the PTFE Cross-Over-Bypass. The advantages of the autologous Cross-Public-Bypass are a large graft diameter, low infection risk, and the transplantation of competent venous valves.