Key result
A hybrid endovascular-surgical approach using a temporary caval filter and preoperative renal artery embolization was successfully performed in 1 patient with massive RCC and caval thrombosis.
Why the study?
Does a combined endovascular and open surgical technique utilizing a temporary atrial caval filter prevent thromboembolism during nephrectomy and thrombectomy in a patient with RCC and extensive caval thrombosis?
Case Report (n=1)
Does a combined endovascular and open surgical technique utilizing a temporary atrial caval filter prevent thromboembolism during nephrectomy and thrombectomy in a patient with RCC and extensive caval thrombosis?
A hybrid endovascular-surgical approach using a temporary caval filter and preoperative embolization may safely facilitate radical nephrectomy and thrombectomy in patients with RCC and extensive caval thrombosis.
May support removable IVC filter use in select neoplastic thrombectomy cases; leaves open prospective safety and efficacy data.
The most common cause of neoplastic thrombotic infiltration of the inferior vena cava is renal cell carcinoma (RCC). In the present report we described a case of a patient with massive RCC and extensive neoplastic thrombosis reaching the retrohepatic tract of the inferior vena cava. After a discussion in a multidisciplinary team meeting we decided to perform a radical nephrectomy with vena cava thrombectomy along with the support of a novel removable vena cava filter in order to avoid thromboembolism during the surgical procedure. Furthermore, a preoperative renal artery embolization with a non-adhesive liquid embolic agent was performed ahead of the surgical procedure in order to reduce the risk of intraoperative bleeding. The surgical procedure performed the day after was based on a hybrid endovascular-surgical approach consisting in nephrectomy, liver derotation, cavotomy with the additional use of a novel temporary caval filter, thus reducing the risk of intraoperative thromboembolic dissemination.
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Fontana et al. (2021) conducted a case report in Renal cell carcinoma with extensive caval thrombosis (n=1). Hybrid endovascular-surgical approach with temporary caval filter and preoperative renal artery embolization was evaluated. A hybrid endovascular-surgical approach using a temporary caval filter and preoperative renal artery embolization was successfully performed in 1 patient with massive RCC and caval thrombosis.
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