LAUSR

A 37-year-old woman with stage IV retroperitoneal leiomyo sarcoma status post-chemotherapy and radiation presented with severe lower extremity edema that was refractory to diuretic therapy. Magnetic resonance imaging (MRI) revealed tumoral encasement of the inferior vena cava (IVC), aorta, celiac trunk, superior mesenteric artery (SMA), bilateral renal veins, and right renal artery (Panel A2, arrowheads). There was a 2 cm segment of thrombosed suprarenal IVC (Panel A1 and A2, arrow) with extensive collateralization via azygos (Panel A1, arrowhead) and lumbar veins. An inferior cavogram demonstrated severe stenosis of juxtarenal IVC with marked collateral flow through the azygos and hemiazygos systems (Panel B1, arrows). A 22 × 70 mm Wallstent (Boston Scientific, Malborough, MA, USA) was deployed just inferior to the cavoatrial junction (Panel B2, arrow). A final cavogram demonstrated good flow through the IVC and cessation of preferential flow through azygos and hemiazygos systems. Sixteen months later, the patient presented with severe worsening of abdominal pain, increasing lower extremity edema, and sudden onset abdominal distention. MRI demonstrated encasement of the main portal vein with severe stenosis and large volume ascites. An inferior vena cavogram demonstrated severe in-stent thrombosis, which was successfully relined with a Venovo stent Multivessel obstruction and treatment in a patient with retroperitoneal leiomyosarcoma