Antegrade balloon occlusion of inferior vena cava during thrombectomy for renal cell carcinoma

Metcalfe, Charles; Chang-Kit, Laura; Dumitru, Ioana; MacDonald, Shaun; Black, Peter C.

doi:10.5489/cuaj.892

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…The standard balloon assisted operative techniques to retract the TT from the inferior vena cava, or to cause IVC occlusion and thereby facilitate bloodless operative field, have been widely in use. These, however, require extracorporeal circulation, hypothermic circulatory arrest, or were solely reserved for the treatment of TT not extending into the right atrium [ 18 – 24 ]. Similarly, Yanaga et al [ 25 ] have described their own technique of TT retraction from the right atrium via balloon assisted 12F aortic catheter, which also required extracorporeal circulation.…”

Section: Discussionmentioning

confidence: 99%

Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report

Sobczyński¹,

Gołąbek²,

Przydacz³

et al. 2015

CEJU

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IntroductionTraditionally, tumor thrombi extending into the right atrium have been managed by open surgery with sternotomy, cardiopulmonary bypass circulation and hypothermic circulatory arrest, and are associated with significant morbidity and mortality rates. Here, we evaluate the results of cavoatrial thrombectomy using our own, Foley catheter assisted-technique, obviating the need for thoracotomy, extracorporeal circulation, and/or hypothermic circulatory arrest.Material and methodsBetween June 2013 and January 2015, 4 consecutive patients underwent cavoatrial thrombectomy performed with our own, Foley catheter assisted technique, via Chevron incision, with no need for extracorporeal circulation or hypothermy for renal cell carcinoma with tumor thrombus extending into the right atrium. Analyses of patients’ data from a prospectively maintained database with respect to perioperative characteristics, morbidity and mortality were performed.ResultsThe total mean duration of surgery was 255 minutes. The mean time of total IVC (inferior vena cava) occlusion was 90 seconds. The average blood loss volume, timed from the beginning of cavotomy incision until its closure, was 1200 ml. The total mean intraoperative blood loss was 3,150 ml. There was no perioperative death. Postoperative complications included one transient acute kidney injury requiring one-off hemodialysis and one re-operation due to bleeding. The follow-up time ranged between 12 to 17 months. None of the patients developed disease recurrence. All patients were still alive at the time of study completion.ConclusionsObtained results support the validity of our own, Foley catheter assisted technique, without cardiopulmonary bypass and hypothermic circulatory arrest for the treatment of renal cell carcinoma with tumor thrombus extending into the right atrium.

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Section: Discussionmentioning

confidence: 99%

Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report

Sobczyński¹,

Gołąbek²,

Przydacz³

et al. 2015

CEJU

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“…The concern with level III and IV thrombi is the need for an extensive hepatic mobilization and a cardiopulmonary bypass, which could result in prolonged surgical time, and increased morbidity and complications 6,7,16–18 . The recent development of using an endoluminal balloon for level III and IV tumor thrombi has led to sufficient vascular control without the need for extensive hepatic mobilization and cardiopulmonary bypass, and in some instances, aided in the removal of the tumor thrombus 6,7,16–19 . Introduction of the balloon catheter can be via the right internal jugular vein, 6,16,18,19 the right femoral vein, 17 or through a cavotomy 7 .…”

Section: Discussionmentioning

confidence: 99%

Balloon catheter as an extraction device for caudal vena cava adrenal tumor thrombectomy in a dog: A case report

2022

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Objective To report the use of a balloon catheter as an extraction device for a posthepatic caval thrombus in a dog with a right adrenal tumor. Animals Twelve‐year‐old male neutered Chihuahua mix dog. Study design Case report Methods The dog presented for the evaluation of a hepatic mass. Computed tomography of thorax and abdomen was performed, and a right lateral liver lobe mass and a right adrenal mass were noted. The adrenal mass had a caval thrombus extending almost to the level of the right atrium. Traditional methods of tumor thrombectomy were unsuccessful. Extraction of the thrombus was facilitated by passing a balloon catheter through the caudal vena cavotomy until it was cranial to the thrombus, inflating the balloon and slowly withdrawing the catheter. Results A malignant pheochromocytoma was diagnosed on histology. The dog had a subjectively assessed good quality of life until it was euthanized 118 days postoperatively for acute dyspnea. Conclusion Balloon catheter‐assisted thrombectomy was successful in removing an extensive caval thrombus that was otherwise difficult to extract via conventional methods. This technique can be considered in cases with extensive tumor thrombus either as a method of choice or when other methods of thrombus extraction have failed.

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“…Eight patients were alive and tumor-free at the last follow-up. Metcalfe et al ( 15 ) modified Yang’s technique by holding the mean arterial pressure at a constant value and using an intraoperative cavogram. Kanka et al ( 16 ) slightly modified these methods for the resection of a level 3 VTT.…”

Section: Discussionmentioning

confidence: 99%

New method for treatment of inferior vena cava tumor thrombus – case study

et al. 2015

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Conventional surgical therapy for advanced renal venous tumor thrombi results in high morbidity, so there is a need for less invasive techniques. This report presents the first case of a successful inferior vena cava (IVC) tumor thrombus removal without complications with balloon catheter (BC) via internal jugular vein (IJV), called the venous tumor thrombus pushing with balloon catheter (VTTP BC). Under the control of transesophageal echocardiogram and fluoroscope, a balloon catheter was sleeved on the guide wire, which was already inserted into the right internal jugular vein (IJV) and was driven distally above the IVC tumor thrombus. The balloon was inflated to occlude the IVC for prevention of pulmonary embolization. After the occlusion, the guide wire was driven to the cavotomy and was opened at the ostium of the right renal vein. It was pulled at both ends and stretched to serve as a rail. The balloon was gently pushed toward the cavotomy and the thrombectomy was completed. This is a less invasive method for treatment of venous tumor thrombus level 3 that can reduce surgical time, blood loss, and complication rates compared to the existing surgical methods. Also, it can be performed without thoracotomy, cardiopulmonary bypass, hypothermic circulatory arrest, and liver mobilization.

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Antegrade balloon occlusion of inferior vena cava during thrombectomy for renal cell carcinoma

Cited by 10 publications

References 13 publications

Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report

Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report

Balloon catheter as an extraction device for caudal vena cava adrenal tumor thrombectomy in a dog: A case report

New method for treatment of inferior vena cava tumor thrombus – case study

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