Surgical Techniques For Treating a Renal Neoplasm Invading The Inferior Vena Cava

Solid organ transplantation is now the standard treatment for many types of diseases and using a standard surgical technique for organ procurement from the deceased donors is an important step in preventing complications after such complicated procedures. In most centers, retrieval of heart, lungs, liver, kidneys, small bowel, pancreas and other organs is done at the same time by different surgeons under supervision by a team leader who is most familiar with at least basic steps of surgical technique of procurement of all the solid organs. Each transplant surgeon, regardless of his or her sub-specialty, has to know how to prepare and dissect the delicate anatomical structures which are in common between the two adjacent organs for example portal vein (liver-pancreas), superior mesenteric vein (pancreas-small bowel), abdominal inferior vena cava (liver-kidneys), supra-diaphragmatic inferior vena cava (liver-heart) and pulmonary artery-veins (heart-lungs). This needs a multidisciplinary approach by the most experienced members of the transplant team to decrease the warm ischemic time of the organs without any harm to them by better coordination between all the surgeons. In this, chapter we briefly describe the multiorgan retrieval procedure in a deceased donor, and we hope that following these instructions results in better quality of the procured organs without jeopardizing their vital anatomical structures.

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Novel Use of Capturex Device and Reliant Balloon for Inferior Vena Cava Tumor Thrombectomy: A Case Report and Review of Literature

Vascular and Endovascular Surgery ◽

10.1177/1538574419831834 ◽

2019 ◽

Vol 53 (4) ◽

pp. 351-354

Author(s):

Derek Ho ◽

Lasitha Samarakoon ◽

Tan Yih Kai ◽

Steven Kum ◽

Darryl Lim

Keyword(s):

Inferior Vena Cava ◽

Radical Nephrectomy ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Surgical Techniques ◽

Uneventful Recovery ◽

Hepatic Veins ◽

Vascular Control ◽

The Right

Introduction: Most common tumor extending into the inferior vena cava (IVC) are renal carcinomas, such extension have been noted in nearly one-fifth of tumors. Tumor thrombectomy improves the prognosis of patients including those with extension of tumor as far as supra hepatic vena cava. In contrast, if radical nephrectomy is performed as the sole procedure, the prognosis is reduced drastically. Case Presentation: We present a case of a 42-year-old male who presented to us with renal cell carcinoma with tumor thrombus extending to IVC. We performed a hybrid endovascular and open procedure using novel surgical techniques to obtain proximal vena caval control and to remove the tumor thrombus—Capturex filter which was placed endovascularly 1 cm above the thrombus via the right internal jugular vein and reliant balloon was placed above the capturex below the hepatic veins. At this position, when the reliant balloon was inflated, it acted as a retro hepatic IVC control. Following vascular control, we proceeded to tumor thrombectomy and radical nephrectomy using transperitoneal approach. Patient made an uneventful recovery and was subsequently referred for medical oncology service for consideration of targeted therapy. Detailed description of the procedure is followed by the discussion of the literature.

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A Rare Case of Stenosis at the Inferior Vena Cava to Right Atrium Anastomosis After Bicaval Orthotopic Heart Transplantation

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253219832608 ◽

2019 ◽

Vol 23 (4) ◽

pp. 418-421 ◽

Cited By ~ 3

Author(s):

Benjamin Abrams ◽

Jordan Hoffman ◽

Muhammad Aftab ◽

Jacob Evers ◽

Tamas Seres

Keyword(s):

Inferior Vena Cava ◽

Heart Transplantation ◽

Right Atrium ◽

Inferior Vena ◽

Rare Complication ◽

Vena Cava ◽

Surgical Techniques ◽

Hemodynamic Instability ◽

Organ Injury ◽

Orthotopic Heart Transplantation

Stenosis at either the superior or inferior caval anastomosis is a rare complication of orthotopic heart transplantation (OHT) and is unique to the bicaval surgical technique. The severity of stenosis dictates the degree of clinical significance, varying from asymptomatic to congestive end-organ injury and hemodynamic instability from impaired preload. Due to differences in the anatomic location of organ congestion, the clinical presentation also depends on which of the 2 anastomoses is involved. In this article, the authors describe a case of stenosis at the inferior vena cava to right atrium anastomosis, which was diagnosed intraoperatively during OHT after weaning from cardiopulmonary bypass. Transesophageal echocardiography provided an accurate and timely diagnosis of this complication, which allowed for immediate surgical correction. Surprisingly, a large, native Eustachian valve was found to be obstructing the anastomosis. Resection of the valve relieved the previously significant narrowing across the anastomosis. This case highlights the importance of thorough intraoperative transesophageal echocardiographic evaluation of graft anastomoses during OHT, as well as an understanding on the part of the echocardiographer of the specific surgical techniques employed during OHT.

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Inferior vena cava thrombus

Phlebologie ◽

10.12687/phleb2142-6-2013 ◽

2013 ◽

Vol 42 (06) ◽

pp. 347-351 ◽

Cited By ~ 1

Author(s):

S.-M. Yuan

Keyword(s):

Inferior Vena Cava ◽

Tumor Thrombus ◽

Inferior Vena ◽

Therapeutic Option ◽

Vena Cava ◽

Surgical Techniques ◽

Advanced Hepatocellular Carcinoma ◽

Hepatic Carcinoma ◽

Ivc Thrombus ◽

Ivc Tumor

Summary Background: The inferior vena cava (IVC) thrombus is an entity with many different causes and clinical presentations. Methods: In the past five years, we treated 16 patients with IVC thrombus and a diagnosis of primary hepatic carcinoma in 6 (37.5%), metastatic hepatic carcinoma in 8 (50%), and Budd-Chiari syndrome in 2 patients (12.5%). Results: Conservative treatment with enhanced immunotherapy, chemotherapy, and transcatheter arterial chemoembolization for the hepatic malignancies led to an overall survial of 82.2% at 16-month follow-up. Discussion: The prognosis of IVC tumor thrombus is usually poor and the surgical techniques are quite challenging. Surgical re-section combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus has led to promising results. Aggressive radical nephrectomy with IVC thrombectomy remains the most effective therapeutic option in patients with renal cell carcinoma and IVC tumor thrombus. With the development of minimally invasive surgical techniques and the avoidance of cardiopulmonary bypass, less trauma and prolonged survival can be expected for IVC thrombus of malignant etiology.

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