Department of Diagnostic and Interventional Radiology, University of Insubria, Circolo Hospital, Varese, Italy.
Department of Urology, University of Insubria, Circolo Hospital, Varese, Italy.
Vasc Endovascular Surg. 2021 Jul;55(5):505-509. doi: 10.1177/1538574421989862. Epub 2021 Feb 4.
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.
下腔静脉肿瘤性血栓浸润最常见的原因是肾细胞癌（RCC）。本报告描述了一例患有大量 RCC 并广泛发生肿瘤性血栓形成的患者，血栓延伸至下腔静脉肝后段。在多学科团队会议上进行讨论后，我们决定进行根治性肾切除术和下腔静脉血栓切除术，并在手术过程中使用新型可移动下腔静脉滤器，以避免血栓栓塞。此外，在手术前还进行了肾动脉栓塞术，使用非粘附性液体栓塞剂，以降低术中出血的风险。手术在第二天进行，采用了混合血管内-手术方法，包括肾切除术、肝脏旋转、腔静脉切开术，并额外使用了一种新型临时腔静脉滤器，从而降低了术中血栓栓塞传播的风险。
