An onco-vascular surgical approach: Internal iliac artery transposition for external iliac artery repair during cytoreductive surgery
Cytoreductive surgery (CRS) in advanced pelvic malignancies may require resection of major vessels, including the external iliac artery (EIA). The aim of this study was to assess the feasibility and safety of ipsilateral transposition of the internal iliac artery as a reconstructive technique for the management of external iliac artery defects. Between 2015 and 2024, six patients underwent CRS with EIA resection and reconstruction using ipsilateral IIA transposition at an expert center in surgical oncology. Postoperative vascular assessment was performed using Doppler ultrasonography and ankle-brachial index (ABI) measurements in all patients, with the exception of one patient who underwent CT angiography and conventional angiography. The cohort included four female and two male patients with a mean age of 58.5 years. Diagnoses included serous ovarian carcinoma (n = 2), liposarcoma (n = 2), and colorectal carcinoma (n = 2); four patients had recurrent disease. Postoperative complications occurred in four patients (67 %), including surgical site infection in two patients, urinary leakage in one patient, and enterocutaneous fistula in one patient; however, no vascular complications were observed. There was no 30-day postoperative mortality, and two patients died within the first year; one from enterocutaneous fistula complications and one from metastatic disease. Among the surviving patients, none developed chronic limb ischemia or any other symptoms related to the vascular anastomosis. Internal iliac artery transposition is a safe and effective autologous reconstruction technique for EIA defects during CRS. This approach offers reliable vascular repair without extending operative time and may support complete oncologic resection while minimizing morbidity.