Antegrade balloon occlusion of inferior vena cava during thrombectomy for renal cell carcinoma
DOI:
https://doi.org/10.5489/cuaj.892Abstract
Nephrectomy with inferior vena cava (IVC) thrombectomy foradvanced renal cell carcinoma (RCC) is a challenging and morbid
surgical case. We describe the use of a simple endoluminal
technique to occlude the suprahepatic IVC during thrombectomy.
A 60-year-old male presented with a large right-sided RCC and
IVC tumour thrombus. The tip of the thrombus, which was nonadherent
to the caval wall, extended to the level of the hepatic
veins. After complete dissection of the kidney, we obtained suprahepatic
control of the IVC by a large compliant balloon, introduced
through the right internal jugular vein and inflated just below the
level of the diaphragm. The IVC thrombectomy was performed
in a bloodless field. Mean blood pressure remained stable during
IVC balloon inflation with a total occlusion time of 10 minutes.
Intraprocedural completion cavogram and postoperative Doppler
ultrasonography showed no residual IVC clot. Blood loss during
the thrombectomy portion of the case was scant. The patient’s
postoperative course was uncomplicated and, at the last followup,
he had stable metastatic disease on sunitinib therapy. For the
surgical treatment of RCC with retrohepatic IVC tumour extension,
transjugular balloon occlusion of the suprahepatic IVC offers an
alternative to extensive hepatic mobilization to obtain suprahepatic
thrombus control. Advantages over traditional surgical methods
may include decreased surgical time, lower risk of liver injury and
tumour embolism. We suggest this method for further evaluation.
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How to Cite
Metcalfe, C., Chang-Kit, L., Dumitru, I., MacDonald, S., & Black, P. (2013). Antegrade balloon occlusion of inferior vena cava during thrombectomy for renal cell carcinoma. Canadian Urological Association Journal, 4(4), E105-E108. https://doi.org/10.5489/cuaj.892
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