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Hatzakorzian R, Blotsky A, Moore A, Vaillancourt J, Mettasittigorn P, Aprikian A, Backman SB. Migration of an Inferior Vena Cava Tumor Thrombus during Renal Cell Carcinoma Resection. Case Rep Anesthesiol 2023; 2023:6632030. [PMID: 38170091 PMCID: PMC10761220 DOI: 10.1155/2023/6632030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Approximately 4%-10% of patients with renal cell carcinoma (RCC) have tumoral vascular invasion with resultant thrombi in the renal vein and in the inferior vena cava (IVC). The authors describe an interesting case of IVC tumor thrombus that migrated to the right cardiac chambers during RCC resection. The diagnosis was made by intraoperative transesophageal echocardiography (TEE), which revealed the presence of a free-floating thrombus between the right atrium (RA) and right ventricle (RV). The patient required an urgent sternotomy with cardiopulmonary bypass (CPB) for atrial thrombus removal prior to the completion of the nephrectomy. The patient made a full recovery and was discharged to a rehabilitation facility. These findings illustrate the importance of intraoperative TEE monitoring during nephrectomy and IVC thrombectomy. In this case, TEE allowed for the diagnosis of an unexpected complication necessitating prompt cardiac surgical management.
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Affiliation(s)
- Roupen Hatzakorzian
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
- Department of Critical Care, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Andrea Blotsky
- Department of Critical Care, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
- Department of General Internal Medicine, McGill University, St-Mary's Hospital, 3830 Lacombe Avenue, Montréal H3T 1M5, Québec, Canada
| | - Albert Moore
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Julien Vaillancourt
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Pattra Mettasittigorn
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Armen Aprikian
- Department of Urology, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Steven B. Backman
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
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Dason S, Mohebali J, Blute ML, Salari K. Surgical Management of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus. Urol Clin North Am 2023; 50:261-284. [PMID: 36948671 DOI: 10.1016/j.ucl.2023.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Most kidney cancers are primary renal cell carcinomas (RCC) of clear cell histology. RCC is unique in its ability to invade into contiguous veins - a phenomenon terms venous tumor thrombus. Surgical resection is indicated for most patients with RCC and an inferior vena cava (IVC) thrombus in the absence of metastatic disease. Resection also has an important role in selected patients with metastatic disease. In this review, we discuss the comprehensive management of the patient with RCC with IVC tumor thrombus, emphasizing a multidisciplinary approach to the surgical techniques and perioperative management.
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Affiliation(s)
- Shawn Dason
- Department of Urology, Ohio State University, 915 Olentangy River Road, Ste 3100, Columbus, OH 43212, USA
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Keyan Salari
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
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