With the development of vascular surgery, the number of vascular operations has increased greatly, but we often neglect the immediate efficacy evaluation during the operation, so that postoperative anastomotic stenosis, obstruction or distal vascular lesions are not detected and treated in time, which affects the efficacy of the operation and even leads to the failure of the operation, increasing the patient’s pain and amputation rate, and even threatening the patient’s life safety. Since 2003, our department has carried out routine imaging in vascular surgery for immediate efficacy evaluation. Leiomyosarcoma (LSM) is a rare malignant tumor of vascular smooth muscle origin. With the improvement of diagnosis in recent years, the detection rate of this disease is also increasing. Three cases have been admitted to our hospital in recent years. Discussion: LSM has low malignancy and slow growth. LSM mostly occurs in veins, especially the inferior vena cava, and less in arteries, and mostly grows outward. 80% of patients are female, and Dzsinick et al. reported that 60% of 210 cases were in the inferior vena cava, and two of the three cases in our group were of inferior vena cava origin. lsm has no specific clinical symptoms, and its clinical manifestations depend on the location of the tumor, growth rate, and the presence of secondary thrombosis. Patients are mostly found with unexplained abdominal mass, abdominal pain and abdominal rise at the time of medical consultation. In one case, the tumor was diagnosed as ureteral disease because it was compressing the ureter and causing hydronephrosis, but the tumor was found to originate from the inferior vena cava during surgery. Patients with endogenous growth of inferior vena cava often show symptoms of inferior vena cava obstruction, such as abdominal rise, bilateral lower limbs swelling, ascites, hepatomegaly, etc. The site of LSM and the extent of invasion can be detected by ultrasound, CT and MRI. The treatment of LSM is based on surgical resection. For LSM of inferior vena cava, iliac vein, femoral vein or saphenous vein origin below the renal vein, surgical excision of the tumor and surrounding tissues is relatively simple, but reconstruction of important veins is necessary, and if the wall involvement is small, partial resection can be followed by molding with artificial vascular patches. In one case, the anterior wall of the inferior vena cava was affected by 2×2 Cm, and the posterior wall was preserved and repaired with a patch after partial resection of the anterior wall. If the wall is more involved or too long, the section of vein must be removed and replaced with an artificial vessel. The addition of an arteriovenous fistula to the iliac and femoral veins is recommended to reduce the chance of thrombosis in the artificial vessel. The rate of surgical resection of LSM in the inferior vena cava above or at the opening of the hepatic vein is very low. Vena-atrial diversion is mostly performed to address the inferior vena cava and hepatic venous reflux. In LSM between the renal vein and the hepatic vein, sometimes the right kidney has to be removed because the tumor invades the right renal vein. If the tumor invades both renal veins, some reports suggest that the left renal vein can be ligated and the inferior vena cava and right renal vein can be removed at the same time, because the left kidney has rich collateral circulation compared with the right kidney, even if the left renal vein is ligated, the survival of the left kidney will not be endangered. Some reports suggest that LSM is not sensitive to either chemotherapy or radiotherapy, and the prognosis of patients depends on the presence or absence of metastasis and whether the tumor is removed.