Finding
Balloon occlusion of the suprahepatic IVC offers a safe alternative to surgical control of this vessel in difficult situations.
Paper
Balloon control of the suprahepatic inferior vena cava: a novel technique for renal cell carcinoma tumor thrombus.
Abstract
Renal cell carcinoma has a tendency to extend via the renal vein into the inferior vena cava (IVC), and we describe a novel approach to this situation. A 64-year-old male presented with metastatic right renal cell carcinoma and tumor thrombus extending into the retrohepatic IVC. Preoperative imaging revealed a large hemangioma adjacent to the IVC, potentially complicating hepatic mobilization. Instead, we used a compliant balloon to occlude the suprahepatic IVC, securing the wire in the right hepatic vein. With the infrarenal IVC and left renal vein occluded, the thrombus was extracted via a right renal venotomy/partial cavotomy with minimal bleeding. Balloon occlusion of the suprahepatic IVC offers a safe alternative to surgical control of this vessel in difficult situations. In addition, it allows for nephrectomy through a conventional, small retroperitoneal incision rather than the extended exposure needed for the IVC. Hepatic vein positioning of the wire prevents thrombus manipulation during balloon placement.
Authors
D. Rigberg, J. Jiménez, P. Lawrence
Journal
Annals of vascular surgery