Case report: Common femoral artery ligation after sarcoma resection in an infant.

Abstract

Vascular reconstruction in infants constitutes a surgical challenge and is indicated frequently for acute occlusions. With the presence of a subacute vascular occlusion, including that produced by tumor resection, collateral circulation develops quickly. Thus a surgeon can consider tumor and vessel resection, without the need for vascular reconstruction. We report the 2-year postoperative outcome of a 2-month-old boy who had a groin synovial cell sarcoma with vascular involvement, treated using limb salvage surgery with resection of the femoral vessels and without performing vascular reconstruction. In adults with military wounds, ligation of the superficial femoral artery and common femoral artery reportedly result in amputation rates of 54% and 86%, respectively. Infants with a common femoral artery ligation may have a lower amputation rate because of some congenital collateral vessels, such as the sciatic artery. Further, when tumors involve major peripheral vessels, subacute or chronic vascular compression likely would facilitate development of collateral circulation. Similar chronic situations have been described in adults treated with debridement and common femoral artery ligation, after infected femoral artery pseudoaneurysms. Considering our patient's history and clinical and radiographic findings, infants with musculoskeletal sarcomas involving vascular structures can be treated selectively with tumor and vessel resection without the need for vascular reconstruction if distal limb perfusion is detected intraoperatively.