Cor Vasa 2016, 58(5):e470-e473 | DOI: 10.1016/j.crvasa.2016.02.005

Chondrosarcoma resection followed by a branched crural revascularization of the right calf: Case report

Róbert Novotný^a,*, Jan Lessenský^b, Jan Hrubý^a, Jaroslav Hlubocký^a, Petr Mitáš^a, Jaroslav Lindner^a

^a II. chirurgická klinika kardiovaskulární chirurgie, Kardiovaskulární centrum, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha, Česká republika

^b Ortopedická klinika, Nemocnice Na Bulovce, Praha, Česká republika

Background: Chondrosarcoma is a malignant bone tumor accounting for 20% of all bone malignancies. We are presenting a case of a lower extremity recurrence of chondrosarcoma that encapsulated the anterior tibial artery and the fibular artery in a 35-year-old Caucasian male patient. The patient underwent a primary resection of a chondrosarcoma of the right lower extremity 3 years ago. The patient underwent regular MRI and CT check-ups of the affected lower extremity. The patient reported a hard palpable mass with intermittent pain attacks and occasional limb swelling on his right calf 3 years from the initial surgery. A CT scan revealed a new tumor arising from the tibial bone in the place of the original tumor resection.
Case presentation: After a CT angiography revealed the tumor's anatomical localization to the surrounding structures, we performed a surgical resection of the entire tumor with a safe margin of soft tissue and encapsulated crural arteries. Extra attention was paid to the preservation of the tibial nerve. The resected crural arteries were replaced with a branched crural reconstruction (popliteal-fibular, anterior tibial bypass). Due to the young age of the patient, the great saphenous vein was the first choice as a graft for the vascular reconstruction. After the tumor resection, the patient was instantly relieved from intermittent pain attack and limb swellings. Based on the preoperative evaluation of the tumor and its surrounding structures, the patient underwent a complete tumor resection with crural arteries reconstruction after which the patient retained full limb functionality. The branched crural arteries reconstruction that replaced the resected crural arteries remains patent up-to-date with no signs of stenosis, when checked by Doppler ultrasonography.

Conclusion: Wide resection is the only adequate surgical treatment of choice and has to be planned carefully.

Keywords: Arterial reconstruction; Branched bypass; Chondrosarcoma; Resection; Tibia

Received: January 31, 2016; Accepted: February 6, 2016; Published: October 1, 2016  Show citation