Intravascular Leiomyomatosis: the Surgical Challenge of Tumors With Cavoatrial Extension To the Editor:

Intravenous leiomyomatosis is an uncommon benign tu-mor of the uterus that proliferates throughout the venous system, but does not invade it (Figure 1). Its treatment re-presents a surgical challenge requiring the coordination of several surgical teams. We describe the operative approach employed in a 44-year-old woman with this lesion and dis-cuss the different surgical options. The operation involved a single procedure, carried out jointly by cardiovascular, peripheral vascular and gynecologic surgeons, via simultaneous midline sternotomy and laparoto-my. First, hysterectomy with bilateral salpingo-oophorectomy was performed, followed by the establishment of cardiopul-monary bypass between ascending aorta and superior vena cava, involving the right appendage as well. After induction of deep hypothermia, circulatory arrest was maintained for 2