Outcomes of Bypass Support Use during Inferior Vena Cava Resection and Reconstruction

Risk of venous thromboembolic events following inferior vena cava resection and reconstruction

“…The surgical techniques used for IVC resection and reconstruction, including indications for intraoperative bypass support, were determined according to the degree of IVC tumor involvement as previously described. 1 In brief, primary repair was performed when the expected IVC narrowing was <50%, patch repair was used in cases in which expected IVC narrowing was >50%, and IVC graft reconstruction was performed in cases in which complete resection of the IVC wall was necessary. For the sake of brevity, all cases of IVC repair (primary or patch) and graft reconstruction are referred to collectively as "IVC reconstruction" throughout the remainder of this report.…”

“…Inferior vena cava (IVC) resection and reconstruction during tumor removal has been previously shown to be safe and effective. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Retroperitoneal malignancies, most commonly renal cell carcinoma or sarcoma, frequently extend into the IVC in advanced cases, at which point neoadjuvant chemoradiation is minimally effective. 2 In these cases, en bloc resection of the tumor, IVC, and related structures is necessary.…”

“…IVC resection and reconstruction can be completed using a range of surgical techniques, including use of cardiopulmonary or veno-venous bypass in cases of projected hemodynamic instability. 1,[8][9][10]17 In cases in which bypass is not required, proximal and distal venous control is usually obtained via cross-clamp. 7 In all instances, there is a perceived risk of thrombus formation because of venous stasis, which is usually an indication for intraoperative systemic heparinization.…”

Mid-term results of surgical interventions of high-grade vena cava tumor thrombus

“…Depending on the level of the tumor thrombus, complication rates after RN and IVC thrombectomy have been found in the literature to be around 30%. [ 8 - 10 ] In our case series, prolonged ventilation developed in nine (27%) patients, regardless of the tumor thrombus stage, and deep vein thrombosis developed in seven (20.5%) patients during their postoperative follow-up, which was accepted as a postoperative complication. Undoubtedly, undesirable complications, such as bleeding, rupture, or massive PTE, that may occur during IVC thrombectomy reduce the success of the surgery and directly affect survival.…”

“…In various case series, the first 30-day mortality of RN and IVC thrombectomy was found to be around 1.5 to 10%. [ 10 ] In our series, one patient in the Stage 3 group died due to intraoperative massive pulmonary embolism. While no mortality was detected in the first 30 days in the remaining 32 patients.…”