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Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare and aggressive mesenchymal tumor, with less than 400 reported cases to date. Complete resection of the tumor with clear margins is the only proven curative treatment, providing survival benefits. Nonetheless, leiomyosarcomas in the middle segment or those extending up to it within the inferior vena cava (IVC) frequently necessitate renal reimplantation or nephrectomy, with rates varying between 56% and 75%. In this case report, we present a 65-year-old female with lower segment IVC leiomyosarcoma with middle segment extension, successfully resected and reconstructed while avoiding associated renal reimplantation or nephrectomy morbidity. [ABSTRACT FROM AUTHOR]

Objective: This study reports the surgical management and outcomes of patients with malignancies affecting the IVC. Methods: This was a retrospective study that considered patients undergoing surgery for IVC thrombectomy in Calgary, Canada, from 1 January 2010 to 31 December 2021. Parameters of interest included primary malignancy, the extent of IVC involvement, surgical strategy, and medium-term outcomes. Results: Six patients underwent surgical intervention for malignancies that affected the IVC. One patient had a retroperitoneal leiomyosarcoma, 1 had hepatocellular carcinoma with thrombus extending into the IVC and right atrium, 1 had adrenocortical carcinoma with IVC thrombus extending into the right atrium, and 3 had clear cell renal cell carcinoma with thrombus extending into the IVC. Surgical strategy for the IVC thrombectomy varied where 5 patients required the institution of cardiopulmonary bypass and underwent deep hypothermic circulatory arrest. No patient died perioperatively. One patient died 15-months post-operatively from aggressive malignancy. Conclusion: Different types of malignancy can affect the IVC and surgical intervention is usually indicated for these patients. Herein, we have reported the outcomes of IVC thrombectomy at our center. [ABSTRACT FROM AUTHOR]

Background: B-type natriuretic peptides (BNP) and cardiac enzymes are both recognized biomarkers of heart health. Many studies have reported that using these indicators can assess cardiac condition and predict prognosis of patients undergoing surgery. Currently little is known on the effect of increased cardiac input after venous recanalization on cardiac physiology in patients with chronic venous obstruction (CVO). Objectives: The aim of this study was to explore the effect of iliocaval recanalization and stenting on cardiac biomarkers in patients with CVO. Methods: This was a prospective study involving 60 patients in a single unit. Blood tests were collected 1 day before and 1 day after venous intervention. Three groups as group 1: patients with iliofemoral post-thrombotic syndrome (PTS) but without involvement of inferior vena cava (IVC) (n = 33); group 2: patients with iliofemoral PTS and involvement of IVC (n = 19) and group 3: patients with non-thrombotic vein lesion (NIVL) (n = 8) were compared based on cardiac biomarker levels. Results: Median concentration of post-operative BNP (259.60 pg/mL) was greater than preoperative levels (49.80 pg/mL) [interquartile range (IQR), 147.15/414.68 versus 29.85/82.88; p < 0.001]. The levels of CK-MB [preop: 3 U/l (IQR, 1.40/11.00) versus postop: 14 U/l (IQR, 12/17), p < 0.001] and troponin T [preop: 3.00 pg/mL (IQR, 3.00/5.25) versus postop: level of 6 pg/mL (IQR, 3.00/9.50), p < 0.001]. Post-procedure increases in cardiac enzymes showed significant differences in BNP (p = 0.023) and troponin T (p = 0.007) across the three groups, while CK-MB levels were not significantly different (p > 0.05). Intergroup comparisons of postoperative BNP: group 1 versus group 2 (p = 0.013), group 2 versus group 3 (p = 0.029), group 1 versus group 3 (p = 0.834); and postoperative troponin T: group 1 versus group 2 (p = 0.018), group 2 versus group 3 (p = 0.002), group 1 versus group 3 (p = 0.282). According to multiple linear regression analysis, length of stenting and level of preoperative BNP were independent determinants of postoperative BNP levels (p < 0.05), and preoperative troponin T affected postoperative troponin T independently (p < 0.05). Conclusions: Troponin T, CK-MB and BNP seem to increase after venous recanalization and stent implantation, the elevation being more prominent for longer lesions. [ABSTRACT FROM AUTHOR]

Background: Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90–100% in case of gunshot wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war for better understanding and future considerations by war surgeons of the vascular trauma management. The aim of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior vena cava. Case presentation: A 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the abdomen from a mortars' explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and received primary surgical treatment within one hour after the injury according to the "golden hour" principle. Then, evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent second-look surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads (packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall defect as well as defects of the inferior vena cava. Conclusions: Application of Damage Control Surgery is a useful approach in the management of severe vascular injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic tool for the searching and removal of ferromagnetic foreign bodies reduces operative trauma and reduces the time for identification of foreign bodies. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) filters are used to prevent fatal and nonfatal pulmonary embolism in patients who otherwise cannot receive anticoagulation for venous thrombosis. While generally safe and effective, complications can arise, especially after prolonged implantation. Timely retrieval is essential once the indication for insertion has resolved. However, encountering patients with long-standing embedded filters is not uncommon. This case report discusses the successful retrieval of a permanent Greenfield IVC filter after 29 years. [ABSTRACT FROM AUTHOR]

The article focuses on renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus, which occurs in 4–10 present of patients and may extend to various stages, requiring an intensive surgical approach for treatment. Topics include the staging of IVC tumor thrombus, the effectiveness of radical nephrectomy and IVC thrombectomy in curing RCC with IVC thrombus, and a case report where the COBRA-OS® vascular balloon system was used to gain proximal control during surgery.

Background: The retrieval of inferior vena cava (IVC) filter is essential for preventing complications associated with the device. Advanced techniques have been developed to improve the success rate of retrieving tip-embedded filters. The forceps technique is frequently used to address this issue. Case presentation: We present a case study of two patients who underwent a successful tip-embedded IVC filter retrieval using a modified forceps technique, which has not been previously reported. This technique involves using a wire loop under the filter tip and a forceps to grasp the filter shoulder. By pulling the wire loop and pushing the forceps in counterforce, the filter tip is straightened and aligned with the vascular sheath. The vascular sheath can then dissect the filter tip out from the caval wall and get inside the sheath to complete the retrieval. Conclusions: The modified forceps technique we present here offers a new solution for the complex retrieval of IVC filters. [ABSTRACT FROM AUTHOR]

There is a paucity of research investigating revision surgery for patients with previous inferior vena cava (IVC) reconstruction using bovine pericardium (BP). To the best of our knowledge, no reports of redo procedures have been published in the medical literature. We describe two cases of redo surgery in patients with previous IVC reconstructions using BP following disease recurrence. The first case underwent resection of the BP graft with a second IVC reconstruction using BP, the second case underwent resection of the BP graft without reconstruction due to extensive thromboses. Neither case experienced perioperative complication or morbidity following their redo procedure, and previous IVC reconstruction with BP did not present significant intraoperative technical challenges. One case showed evidence of endothelialisation of the excised BP graft, however, it was not possible to definitively conclude if endothelialisation was present in the second case. Overall, these cases demonstrate that previous IVC reconstruction using BP should not be considered an absolute contraindication for redo surgery in the context of disease recurrence. [ABSTRACT FROM AUTHOR]

Venous stenting could alleviate exercise intolerance associated with chronic inferior vena cava (IVC) obstruction. We describe a 36-year-old male patient with an unknown IVC-obstruction. The obstruction was discovered after a bi-iliac deep vein thrombosis (DVT). The thrombus was resolved using thrombolysis. In the chronic phase, the patient developed exercise intolerance without any leg-specific symptoms or signs. Venous stenting was performed to open the IVC-obstruction, 1 year after the acute DVT. His physical condition improved, but cardiac magnetic resonance imaging at rest did not reveal hemodynamical changes after stenting. The Short Form Health Survey (SF-36) physical and mental component summaries were increased from 40.3 to 46.1 and 42.2 to 53.7, respectively. In patients with iliocaval obstruction, improved venous flow without changes in resting hemodynamics can enhance exercise intolerance and quality of life, even in the absence of leg symptoms. Diagnostic tools performed only at rest may miss abnormalities. [ABSTRACT FROM AUTHOR]

Introduction: Pulsed field ablation (PFA) is a nonthermal ablative strategy that achieves cell death via electroporation. Herein, we investigated the preclinical safety and efficacy of PFA using two novel 8‐French, 16‐electrode spiral PFA/mapping catheters (ElePulse; CRC EP, Inc.). Methods: Bipolar PFA (>1.8 kV) was performed using 30 s, single‐shot, QRS‐gated applications. Altogether, 94 atrial structures were ablated in 23 swine, one canine, and one ovine, including right and left atria and atrial appendages, pulmonary veins, and superior and inferior (IVC) vena cavae. We also examined the impact of PFA on the phrenic nerve (14 swine) and on a deviated esophagus after delivery of PFA from inside the IVC (five swine). Results: All applications were single‐shot without catheter repositioning. Minimal microbubbling was observed without significant skeletal muscle twitching/activation (mean acceleration: 0.05 m/s2). There was a marked reduction in post‐PFA versus pre‐PFA atrial electrogram amplitude (0.17 ± 0.21 vs. 1.18 ± 1.08 mV; p <.0001). Lesion durability was demonstrated up to 3 months in all targeted tissues. Histologically, lesions were contiguous and transmural, except in the atrial appendage, and without any thermal effects. Magnetic resonance, gross, and histologic examinations of the brain, rete mirabile, and kidneys revealed no thromboembolism. No acute/long‐term phrenic nerve dysfunction was encountered. Although within 2 h of ablation, histologic examinations of the esophagus revealed acute PFA‐related changes in the muscular layer, these completely resolved by 21 ± 5 days. Conclusion: A novel, single‐shot, spiral PFA system is capable of safely creating large, durable atrial lesions without significant adverse effects on the phrenic nerve or the esophagus. [ABSTRACT FROM AUTHOR]

A simplified technique of performing the extracardiac Fontan operation on cardiopulmonary bypass is described. The advantages of this technique are briefly discussed. [ABSTRACT FROM AUTHOR]

Introducion: Renal cell carcinoma (RCC) is one of the most prevalent malignant tumors. It extends up into the systemic veins and right atrium. Surgical extraction of such extensions is usually carried out using cardiopulmonary bypass (CPB) with moderate hypothermic (MH) being frequently applied in order to obtain a clear surgical field. However, due to obvious disadvantages of hypothermia, approaches with mild/normothermia (NT) during CPB have also been established. The current study aims to compare the outcomes of patients undergoing RCC tumor and extensions resection using MH versus NT. Material and Methods: This is a retrospective, non-randomized study. All patients who underwent RCC tumor and extensions resection for stage III or IV (Staehler) RCC in a single center between 2006 and 2020 were included. During surgery, MH or NT were applied. CPB was realized using aortic and bicaval cannulation. We compared the procedural times, transfusion requirements and postoperative outcomes, respectively between the MH and NT groups. Results: A total of 24 consecutive patients (n(NT) = 12, n(MH) = 12) were included in the study (median age NT 68.5 and MH 66.5). The study only showed a significant difference in heart-lung machine times (median CPB time NT 45.5 min and MH 110.0 min, p = 0.004). All other results, loss of drainage, administration of blood products, as well as the postoperative course and mortality were comparable in both groups. Conclusion: The results showed a high perioperative and long-term mortality. The perioperative course was similar after surgery with NT or MH. Therefore, NT which minimizes potential complications of MH should be preferred. [ABSTRACT FROM AUTHOR]

Background: Complex congenital anomalies of the inferior vena cava (IVC) are rare sequelae of inappropriate persistence or regression of embryological precursor veins. These anomalies are typically asymptomatic and generally do not warrant intervention. Case Presentation: Here we present a case of severely symptomatic left IVC with infrahepatic disruption, azygos continuation, and retroaortic left renal vein causing symptoms of severe pelvic congestion and recurrent miscarriages (8 total) in a 41 year old female. The patient was treated with stenting of the compressed retroaortic portion of the IVC/left renal vein. Four months post-procedure, the stent remained patent and the patient reported considerable improvement in their venous congestion symptoms. Most notably, as of the writing of this report, the patient is 38 weeks pregnant. Conclusions: The case is notable for its severe symptomatology of pelvic venous disease including recurrent miscarriage. More importantly, it represents the first documented case of successful retroaortic endovascular management of such a venous anomaly, in which the entirety of the typical IVC drainage occurred via a compressed left-to-right retroaortic crossover. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety, feasibility and technical aspects of endovascular treatments for inferior vena cava (IVC) thrombosis secondary to deep venous thrombosis of the lower extremities. Materials and Methods: A retrospective study of patients from two centres who received endovascular treatment for IVC thrombosis from January 2015 to December 2020. Under the protection of the IVC filter, all lesions were treated with manual aspiration thrombectomy (MAT) followed by catheter-directed thrombolysis (CDT). Technical aspects, complications, IVC patency, Venous Clinical Severity Score (VCSS) score and Villalta score were recorded during the follow-up observation. Results: Endovascular procedures including MAT and CDT were performed successfully in 36 patients (97.3%). The average duration of the endovascular procedure was 71 minutes (range: 35-152 min). To protect against fatal pulmonary artery embolism, 33 filters (91.7%) were deployed in the inferior renal IVC, while three patients (8.3%) received filter implantation in the retrohepatic IVC. No severe complications occurred during the procedure. In the follow-up observations, the cumulative primary and secondary patency rates in IVC were 95% and 100%, respectively. The patency rates for the iliac vein were as follows: a primary patency rate of 77% and a secondary patency rate of 85%. The average VCSS score was 5.9 ± 2.6, and the Villalta score was 3.9 ± 2.2. The rate of post thrombotic syndrome is 22% in our study as assessed by the villalta score (Villalta score>4). Conclusions: Endovascular treatment for IVC thrombosis secondary to DVT of the lower extremities is feasible, safe, and effective. This strategy alleviates venous insufficiency and results in a high patency rate in IVC. [ABSTRACT FROM AUTHOR]

Objective: Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting across the injured segment offers an alternative to open surgical management. We present a series of patients with operative injury to the inferior vena cava (IVC) and iliac veins who were treated utilizing an endovascular approach and review the available literature on this technique. Methods: A PubMed keyword and MeSH term search was performed, and titles were reviewed for relevance by the first author. Studies related to endovascular repair of iatrogenic injury to the IVC and iliac veins were then read in detail for possible inclusion in the review. Those deemed appropriate were further analyzed for interventional approach, stent type and size, technical success, post-procedural pharmacologic management, complications and surveillance strategy. Results: The initial search resulted in 6221 publications. A total of 17 met criteria for inclusion, all of which were case reports or series. Twenty-six patients were described as suffering iatrogenic injury to the IVC or iliac veins, treated with various types and sizes of stents. All cases achieved technical success with hemorrhage control. Procedural complications occurred in 15.4% of cases, including 3 cases of acute thrombus formation and 1 case of stenosis caudal to the initial stent edge requiring additional stenting. Two additional patients experienced stent occlusion in the surveillance period. Conclusions: Endovascular repair of iatrogenic injury to the IVC and iliac veins can be an effective management option. However, due to limited data regarding this approach, many technical questions remain, including ideal size and type of stent graft, necessity and duration of post-procedural anticoagulant or antiplatelet therapy and appropriate surveillance. Additionally, long term outcomes in this population have not yet been described. [ABSTRACT FROM AUTHOR]

Introduction: Congenital malformations of the inferior vena cava are rare and remain an under recognised cause of spontaneous deep venous thrombosis (DVT). The purpose of this case report is to highlight the rare occurrence of a concomitant iliac vein aneurysm and the feasibility of endovascular reconstruction in the presence of extensive iliocaval thrombus burden, especially in cases where other treatment modalities have been unsuccessful. Report: This is the report of a 25-year-old male who presented with acute onset left lower limb pain/swelling secondary to extensive iliocaval DVT. This was due to multiple abnormalities of the venous system including hypoplasia of the IVC with aneurysmal dilatation of the iliac veins. He failed an initial management strategy of anticoagulation and thrombolysis but subsequently underwent endovascular reconstruction of the iliocaval system via venoplasty and stenting. Complete symptom resolution and venous patency, including resolution of venous aneurysmal disease, were maintained at twelve-month follow-up. Discussion: Reduction of the iliac vein diameter so early after successful reconstruction suggests that the iliac venous aneurysm was secondary to significant venous hypertension, and that if the obstruction causing it is treated, the vein can return to a normal vessel diameter. [ABSTRACT FROM AUTHOR]

A potential complication of complex endovascular procedures is retained foreign bodies such as fragmented catheters, wires, stents, or sheaths in the intravascular space. Different techniques are available for retrieval of intravascular foreign bodies including snares, forceps, baskets, tip-deflecting wires, and balloon catheters. The aim of this article is to describe our experience in which a lost large intravascular sheath was retrieved using balloon assistance. We also provide a review of different techniques used for intravascular large sheath retrieval and methods to avoid this complication during endovascular procedures such as complex inferior vena cava filter removal. [ABSTRACT FROM AUTHOR]

The recirculation of venovenous extracorporeal membrane oxygenation (VV-ECMO) will decrease the efficiency of respiratory support. We report a patient with refractory severe acute respiratory distress syndrome (ARDS). Even with the support of ECMO and mechanical ventilation (MV), it is still difficult to correct hypoxemia. In this case, we placed a balloon catheter above the ECMO drainage cannula in inferior vena cava (IVC), and then occlusion the IVC with the water-filled balloon. After the occlusion, the patient's hypoxemia was quickly improved, and angiography proved that the recirculation has been significantly reduced. In this case, IVC occlusion technology greatly reduces recirculation. Its advantages lie in simple operation, low cost, short term safety, which probably act as an innovative method to reduce recirculation. [ABSTRACT FROM AUTHOR]

Objective and design: An accumulating body of evidence has shown that gut microbiota is involved in regulating inflammation; however, it remains undetermined if and how gut microbiota plays an important role in modulating deep venous thrombosis (DVT), which is an inflammation-involved thrombotic event. Subjects: Mice under different treatments were used in this study. Methods and treatment: We induced stenosis DVT in mice by partially ligating the inferior vena cava. Mice were treated with antibiotics, prebiotics, probiotics, or inflammatory reagents to modulate inflammatory states, and their effects on the levels of circulating LPS and DVT were examined. Results: Antibiotic-treated mice or germ-free mice exhibited compromised DVT. Treatment of mice with either prebiotics or probiotics effectively suppressed DVT, which was accompanied with the downregulation of circulating LPS. Restoration of circulating LPS in these mice with a low dose of LPS was able to restore DVT. LPS-induced DVT was blocked by a TLR4 antagonist. By performing proteomic analysis, we identified TSP1 as one of the downstream effectors of circulating LPS in DVT. Conclusion: These results suggest that gut microbiota may play a nonnegligible role in modulating DVT by leveraging the levels of LPS in circulation, thus shedding light on the development of gut microbiota-based strategies for preventing and treating DVT. [ABSTRACT FROM AUTHOR]

Simple Summary: Most of the existing data on the resection of liver metastases with inferior vena cava infiltration come from case reports or small case series. This systematic review on the subject found postoperative morbidity and mortality rates and overall survival to be acceptable, offering a surgical alternative to these patients previously considered unresectable. Combined hepatic and inferior vena cava (IVC) resection is the only potentially curative treatment for patients with colorectal liver metastases (CRLM) involving the IVC. Most of the existing data come from case reports or small case series. In this paper, a systematic review based on the PICO strategy was performed in accordance with the PRISMA statement. Papers from January 1980 to December 2022 were searched in Embase, PubMed, and the Cochrane Library databases. Articles considered for inclusion had to present data on simultaneous liver and IVC resection for CRLM and report surgical and/or oncological outcomes. From a total of 1175 articles retrieved, 29, including a total of 188 patients, met the inclusion criteria. The mean age was 58.3 ± 10.8 years. The most frequent techniques used were right hepatectomy ± caudate lobe for hepatic resections (37.8%), lateral clamping (44.8%) for vascular control, and primary closure (56.8%) for IVC repair. The thirty-day mortality reached 4.6%. Tumour relapse was reported in 65.8% of the cases. The median overall survival (OS) was 34 months (with a confidence interval of 30–40 months), and the 1-year, 3-year, and 5-year OS were 71.4%, 19.8%, and 7.1%, respectively. In the absence of prospective randomized studies, which are difficult to perform, IVC resection seems to be safe and feasible. [ABSTRACT FROM AUTHOR]

Objectives: Hepatocaval ligament is localized on the posterior and lateral side of the retrohepatic Inferior Vena Cava (IVC), above the right adrenal vein. Bleeding due to retro-hepatic cava injury could sometimes occur during the dissection and closure of hepatocaval ligament (HCL). We aim to determine closing methods of HCL in terms of cost, ease of application and safety. Methods: The study population included 90 recipient hepatectomy patients who had cadaveric and live-donor liver transplantation at Organ Transplant Center of Acıbadem Hospital between 2017 and 2019. The patients were divided into two groups. The first group contained 40 patients who were closed with 25 mm EndoTA 30 stapler. The second group contained 50 patients who were closed by continuous double- layer suturing with 5/0 propylene. Results: In the group closed by endovascular stapler, reinforcement suturing was performed in eight patients (20%) using 5/0 propylene suture due to mild blood leakage in the closing line. In two patients (5%), on the other hand, the staple device could not be used due to the fact that HCL was very close to the right hepatic vein and the distance between the liver and the vena cava was short. There were no perioperative and postoperative HCL-associated liver and vena cava bleeding complications in both groups. However, the cost was significantly higher in the stapler group than in the suturing group. Conclusions: The present study is the first to compare the stapler or suturing techniques for closing HCL in the receiver hepatectomy of liver transplantation. The results indicated that the closure with suturing was at least as useful and convenient in terms of cost, ease of application and safety. [ABSTRACT FROM AUTHOR]

Background: Differential hypoxemia (DH) has been recognized as a clinical problem during veno-arterial extracorporeal membrane oxygenation (VA ECMO) although its features and consequences have not been fully elucidated. Purpose: This single center retrospective study aimed to investigate the clinical characteristics of patients manifesting DH as well as the impact of repositioning the drainage point from the inferior vena cava (IVC) to the superior vena cava to alleviate DH. Methods: All patients (>15 years) commenced on VA ECMO at our center between 2009 and 2020 were screened. Of 472 eligible patients seven were identified with severe DH. All patients had the drainage cannula tip in the IVC or at the junction between the IVC and right atrium. Results: The mean peripheral capillary saturation increased from 54 (±6.6) to 86 (±6.6) %, (p = <0.001) after repositioning of the cannula. Pre-oxygenator saturation increased from 62 (±8.9) % prior to adjustment to 74 (±3.7) %, (p = 0.016) after repositioning. Plasma lactate tended to decrease within 24 h after adjustment. Five patients (71%) survived ECMO treatment, to discharge from hospital, and were alive at 1-year follow-up. Conclusion: Although DH has been described in several studies, the condition has not been investigated in a clinical setting comparing the effect on upper body saturation before and after repositioning of the drainage cannula. This study shows that moving the drainage zone into the upper part of the body has a marked positive effect on upper body saturation in patients with DH. [ABSTRACT FROM AUTHOR]

Introduction: Sarcomas of vascular origin are rare. A case of Ewings sarcoma of Inferior Vena Cava [IVC] is reported here. Report: A 36-year-old lady presented with a 6-month history of bilateral pitting lower limb swelling and 1-month history of vaginal bleeding. Contrast-enhanced computed tomography of the thorax and abdomen revealed a soft tissue lesion extending from the cavoatrial junction to the junction of the middle hepatic vein with IVC. She underwent IVC resection (suprahepatic) and left lateral hepatectomy with dacron graft reconstruction. The pathology was suggestive of Ewings sarcoma and she received adjuvant chemotherapy. Conclusion: Preoperative tissue diagnosis can be considered in vascular tumors to sequence the various treatment modalities for improved outcomes. [ABSTRACT FROM AUTHOR]

The authors discuss a study published by Aryana and colleagues in the issue which evaluated the efficacy and safety of novel bipolar, biphasic spiral-shaped pulse-field ablation (PFA) catheter in vivo. Topics include substantial interest in the development of PFA, how PFA works, and benefits of this novel catheter system compared to previously studied catheters.

Injury to the inferior vena cava (IVC) can produce bleeding that is difficult to control. Endovascular balloon occlusion provides rapid vascular control without extensive dissection and may be useful in large venous injuries, especially in the juxtarenal IVC. We describe the procedural steps, technical considerations, and clinical scenarios for using the Bridge occlusion balloon (Philips) in IVC trauma. We present a single-center case series of 5 patients in which endovascular balloon occlusion of the IVC was used for hemorrhage control. All 5 patients were men (median age 35, range 22 to 42 years). They all sustained penetrating injuries—4 gunshot wounds and 1 stab wound. Median presenting Shock Index was 0.7 (range 0.5 to 1.5). Median initial lactate was 5.4 mmol/L (range 4.6 to 6.9 mmol/L). There were 2 suprarenal IVC injuries, 2 juxtarenal injuries, and 3 infrarenal injuries. Four patients underwent primary repair of their injury, and one underwent IVC ligation. Four patients had intraoperative Resuscitative Endovascular Balloon Occlusion of the Aorta for inflow control and afterload support. The median number of total blood products transfused during the initial operation was 37 units (range 16 to 77 units). Four patients underwent damage control operations, and one patient had a single definitive operation. Four of the 5 patients (80%) survived to discharge with the lone mortality being due to other injuries. Endovascular balloon occlusion serves as a valuable adjunct in the management of IVC injury and demonstrates the potential of hybrid open–endovascular operative techniques in abdominal vascular trauma. [ABSTRACT FROM AUTHOR]

Malignant invasion of the inferior vena cava (IVC) often necessitates complete tumor thrombectomy and IVC reconstruction. Bovine pericardial xenografts and prosthetic grafts are frequently used for partial or entire IVC reconstruction with adequate subsequent patency and freedom from thrombosis. Cryopreserved aortic homografts represent an alternative conduit for vena cava replacement with resistance to infection in contaminated fields or following extensive retroperitoneal dissection. Specific reports of aortic homograft use for IVC reconstruction are scarce. Described are 2 cases of cryopreserved aortoiliac artery allograft use for long segment cava patch repair while avoiding extensive caval reconstruction, mobilization and the need for renal vein and hepatic vein re-implantation. [ABSTRACT FROM AUTHOR]

Three young males with Hugh-Stovin's syndrome presented with cough, haemoptysis, fever, raised inflammatory markers, and pulmonary artery aneurysm. Only one had recurrent oral ulcers suggestive of Behcet's disease, and none were HLA B51 positive. All responded well to immunosuppression but eventually needed either an endovascular procedure or surgery. [ABSTRACT FROM AUTHOR]

Iliocaval thrombosis is a major source of morbidity for patients, with a range of clinical presentations, including recurrent lower extremity deep venous thrombosis and postthrombotic syndrome. Endovascular reconstruction of chronic iliocaval occlusion has been demonstrated to be a technically feasible procedure that provides long-lasting symptom relief in combination with antithrombotic therapy and close clinical monitoring. Herein, we describe the etiologies of iliocaval thrombosis, patient assessment, patient management prior to and after intervention, procedural techniques, and patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Leiomyosarcoma of the inferior vena cava (IVC) is rare. The study reviewed patients with IVC leiomyosarcoma in our hospital in the past ten years. Methods: Twenty patients diagnosed with IVC leiomyosarcoma between October 2010 and October 2020 were enrolled. Their clinical manifestations, treatments, and follow-up results were analyzed. Results: The sarcoma was located in the lower IVC segment in six patients, with 13 in the middle and one in the upper IVC segment. Eighteen patients underwent R0 resection. After resection, 16 patients (80%) had primary repair of the IVC, while four patients underwent ligation. During a mean follow-up of 37.7 months, seven patients died due to tumor metastasis, four patients were alive with the tumor recurrence and other nine patients were alive without recurrence. Conclusion: The management of the IVC after tumor resection depended on the tumor location and size. R0 resection provided a chance for long term survival. [ABSTRACT FROM AUTHOR]

Wilms tumor is a frequent malignant neoplasia in pediatric population. Extension to the inferior vena cava is a complication that occurs in approximately 4%-15% of cases. Surgical techniques derived from the field of adult transplant surgery allow the resection of the tumor with its thrombus extension. In the case of a 6-year-old male patient with a stage III Wilms tumor that originated from the left renal vein, thrombectomy and left radical nephroureterectomy were accomplished without extracorporeal circulation. Surgical technique applied in adult transplant surgery for removal of advanced renal tumors, could be a safe and feasible technique in pediatric population. [ABSTRACT FROM AUTHOR]

Surgical procedures of the retroperitoneum are often performed in gynecologic oncology surgery clinics. The most complex among them is paraaortic lymphadenectomy. It is generally performed in cases of bulky lymph nodes in ovarian carcinomas and sarcomas to achieve optimal cytoreduction. In the early stages of ovarian cancer, type II non-endometrioid endometrial cancer, and in advanced stages of cervical cancer, paraaortic lymphadenectomy is an integral part of staging. Moreover, the retroperitoneum is approached in cases of retroperitoneal gynecologic sarcomas. The largest vessels of the human body – the inferior vena cava and the abdominal aorta are localized in the retroperitoneum. Therefore, iatrogenic vessel injury during oncogynecological surgery is more likely to affect the inferior vena cava. Anatomical variations of the vein additionally increase the risk of vascular lesions. Therefore, surgeons should be aware of possible anatomical variations. The present article aimed to highlight the heterogeneity of anatomical variations of the inferior vena cava related to gynecologic oncology surgery. Embryogenesis of the vein and its variations are also discussed. Additionally, some anomalies of the ureter, associated with the embryogenesis of the inferior vena cava, are mentioned. [ABSTRACT FROM AUTHOR]

Introduction: Femoral cannulation for veno-venous extracorporeal membrane oxygenation is challenging in infants because of the diameter of the vein. Case report: Prolonged ECMO support (67 days) was necessary for an 8-month-old (8 kg) girl with acute respiratory distress syndrome that was caused by H1N1 influenza. After 30 days on ECMO support and using a single 16 Fr double-lumen cannula (internal jugular vein), a second cannula was necessary to ensure adequate flow. This second 12 Fr single-lumen cannula was surgically placed through the right common iliac vein. An excellent flow profile was then achieved and ECMO continued successfully for 37 more days. Discussion: As a lifesaving option, this double caval configuration successfully optimized the flow profile and oxygenation, outweighing the related risks. Conclusion: In small children, a surgical approach to the inferior vena cava can be considered safe, especially in those cases where there is a shortage of adequate cannulas, or when central venous access is difficult. [ABSTRACT FROM AUTHOR]

Background: Renal cell carcinoma (RCC) with tumor thrombus (TT) may extend into and, in rare cases, actually invade the inferior vena cava (IVC). Techniques of IVC reconstruction after removal of the RCC, TT, and infiltrated portion of the IVC have not been well documented. Methods A ringed polytetrafluoroethylene (PTFE) interposition graft along with an IVC filter placed within the graft (to prevent the development of pulmonary emboli) was used for patients who underwent surgical resection of RCC with TT extending into and directly invading the wall of the IVC. Demographic information about these patients along with their pathology reports, surgical procedures, and patency of the PTFE graft was obtained and described. Results Four male patients were identified as having RCC and TT with histologic invasion of the IVC requiring IVC dissection and replacement with a PTFE graft (as described above); their TT levels were II, IIIa, IIIc, and IV, respectively. Patient ages were 58, 65, 58, and 51 years and tumor sizes were 7.5, 7.5, 15.0, and 6.5 cm, respectively. These patients were followed for 36, 24, 32, and 48 months, respectively. At last follow-up, each patient had a patent IVC graft, and none of them developed any pulmonary emboli post-operatively. Conclusions Ringed PTFE interposition graft along with an IVC filter deployed inside the graft appears to be a safe vascular conduit for IVC reconstruction after surgical resection of RCC with TT directly invading the IVC. [ABSTRACT FROM AUTHOR]

This is a report of an iatrogenic inferior vena cava (IVC) segmental resection and reconstruction utilizing bovine pericardium. A 48-year-old female patient presented for a planned right nephrectomy by the urology service secondary to xanthogranulomatous pyelonephritis. This was complicated by inadvertent resection of an 8 cm segment of the infrarenal IVC. Postoperatively, the patient did not tolerate IVC ligation due to severe lower extremity edema. She then underwent reconstruction with a bovine pericardium conduit as an interposition graft. The post-operative course was complicated by pulmonary embolism requiring percutaneous intervention. This report addresses the utility of bovine pericardium for IVC reconstruction in an infected field. [ABSTRACT FROM AUTHOR]

Background: Radical nephrectomy with thrombectomy is the mainstay treatment for patients with renal cell carcinoma with vena cava thrombus. But the procedure is full of challenge, with high incidence of major complications and mortality. Herein, we investigated the incidence and predictors of myocardial injury and acute kidney injury (AKI) in patients following radical nephrectomy with inferior vena cava thrombectomy. Methods: Patients who underwent nephrectomy with thrombectomy between January 2012 and June 2020 were retrospectively reviewed. Myocardial injury was diagnosed when peak cardiac troponin I was higher than 0.03 ng/ml. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression models were used to identify predictors of myocardial injury or AKI after surgery. Results: A total of 143 patients were included in the final analysis. Myocardial injury and AKI occurred in 37.8 and 42.7% of patients after this surgery, respectively. Male sex (odds ratio [OR] 0.27, 95% confidence interval [CI] 0.10–0.71; P = 0.008) was associated with a lower risk, whereas high level Mayo classification (compared with Mayo level I + II, Mayo level III + IV: OR 4.21, 95% CI 1.42–12.4; P = 0.009), acute normovolemic hemodilution before surgery (OR 2.66, 95% CI 1.10–6.41; P = 0.029), long duration of intraoperative tachycardia (per 20 min: OR 1.49, 95% CI 1.10–2.16; P = 0.036), and long duration of surgery (per 1 h, OR 1.48, 95% CI 1.03–2.16, P = 0.009) were associated with a higher risk of myocardial injury. High body mass index (OR 1.18, 95% CI 1.06–1.33; P = 0.004) and long duration of intraoperative hypotension (per 20 min: OR 1.30, 95% CI 1.04–1.64; P = 0.024) were associated with a higher risk, whereas selective renal artery embolism before surgery (OR 0.20, 95% CI 0.07–0.59, P = 0.004) was associated with a lower risk of AKI. Conclusion: Myocardial injury and AKI were common in patients recovering from radical nephrectomy with inferior vena cava thrombectomy. Whether interventions targeting the above modifiable factors can improve outcomes require further studies. [ABSTRACT FROM AUTHOR]

Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock. [ABSTRACT FROM AUTHOR]

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation. [ABSTRACT FROM AUTHOR]

This study evaluates the feasibility of retrohepatic inferior vena cava (RHIVC) resection without reconstruction in patients with end-stage hepatic alveolar echinococcosis (AE). Four hundred and fifty-seven patients diagnosed with hepatic AE and who underwent surgical resections between January 2010 and October 2018 were retrospectively analyzed. Nine patients receiving RHIVC resection without reconstruction were included in this study. Among the patients, 5 were male and 4 female. Mean follow-up time was 64.4 months (18-95). In this series, adequate collateral circulation was formed before operation in all patients, and 7 cases underwent ex vivo liver resection and autotransplantation (ELRA) and 2 cases underwent extended right hemi-hepatectomy. Average standard liver volume, graft volume, surgical time, and anhepatic phase in ELRA group patients was 1144 ± 127 cm3, 740 ± 235 cm3, 16.8 ± 4.1 hours, and 337.4 ± 108.65 minutes respectively. Average hospital stay time for all patients was 45 ± 36.4 days. There were no intraoperative deaths. The 30-day mortality rate was 11.1%, and total mortality rate was 22.2%. Postoperative complications occurred in 4 patients. During follow-up, no relapsed AE lesions were found. RHIVC resection without reconstruction is a feasible way for hepatic AE patients with adequate collateral circulation. Careful protection of collateral venous is the key factor for successful operation. [ABSTRACT FROM AUTHOR]

Venous stent placement of symptomatic occlusion of the superior and inferior vena cava is considered the treatment of choice in malignant disease because this technique can restore patency and achieve a relief of symptoms. However, tumor thrombus extension into the right atrium harbors the potential risk of stent migration and perforation. One strategy to avoid this potential life-threatening complication could be the placement of a bridging stent from the superior vena cava-to-inferior vena cava. This case reports describes the superior vena cava-to-inferior vena cava bridging stent technique in 2 patients with malignant occlusion of the superior and inferior vena cava. Special considerations such as technical details of the devices and potential complications are discussed. [ABSTRACT FROM AUTHOR]

The objective of present study was to evaluate the feasibility and safety of a novel endovascular sealing device for distal re-entry tears in type B aortic dissection in a porcine model. Distal re-entry tears are a well-recognized risk factor for unfavorable aortic remodeling after thoracic endovascular aortic repair. However, there is currently no device for sealing a distal re-entry tear. We implanted the ENDOPATCH device (Weiqiang Medical, Hangzhou, China) in 15 pigs (40–50 kg) under angiographic guidance. The device can be retrieved and repositioned with an 8–10 French sheath. All pigs were assessed using angiography before sacrifice 1- (n = 1), 3- (n = 1), and 6 months (n = 13) after implantation, which was followed by gross specimen evaluation and histological examination of harvested tissues. The ENDOPATCH device was successfully implanted in all 15 pigs. The mean disk diameter of the implant was 10.3 ± 1.7 mm, and the chosen device was 4.4 ± 0.9 mm larger than the measured maximum diameter of the fistula. No device migration or leakage was observed angiographically, before sacrifice. An organized thrombus on the disk surface was found in the inferior vena cava of one pig. Complete sealing of the fistula was confirmed by gross and microscopic examinations in all pigs. Our results indicated that the ENDOPATCH device is feasible and safe in a porcine model. Human studies are needed to evaluate the safety and efficacy of the ENDOPATCH. • The porcine model simulated the hemodynamics of an intimal tear of aortic dissection. • The ENDOPATCH device is feasible and safe in a porcine model. • The ENDOPATCH revealed excellent sealability in a porcine arteriovenous fistula. [ABSTRACT FROM AUTHOR]

Congenital portosystemic shunt (CPSS) is a rare disorder characterized by a diversion of Porto-mesenteric blood into systemic veins. Type I is an end to side fistula between the portal vein and the inferior vena cava. Type II is a side to side fistula between the main portal vein or its branches and mesenteric, splenic, gastric, and systemic veins. Clinical presentation of these patients varies. Treatment and management are guided by the type of malformation and clinical presentation. Herein, we present a case of CPSS Type IIb with neurological symptoms, treated with endovascular occlusion with 6-year follow-up without remission. [ABSTRACT FROM AUTHOR]

Aims: Severe tricuspid regurgitation (TR) is a common finding in heart failure patients and associated with increased mortality. New interventional therapeutic options are needed as many heart failure patients are unfit for surgery. The TRICAVAL study compared valve implantation into the inferior vena cava (CAVI) with optimal medical therapy (OMT) in patients with severe TR. Here, we report details on the impact of CAVI on TR severity as well as right heart function and morphology. Methods and results: We randomized 28 patients with severe TR to CAVI (n = 14) with transfemoral implantation of an Edwards Sapien XT valve into the inferior vena cava or OMT (n = 14). Inclusion and exclusion criteria were based on anatomical and clinical parameters. Echocardiographic measurements were performed at baseline, at the first postoperative day and one, three, and twelve months after randomization. As proof of concept of an effective sealing of the inferior vena cava, we detected a significant decrease in systolic hepatic vein reflux volume (11.0 [6.2–21.9] mL vs 3.5 [0.6–8.5] mL, P =.016) and hepatic vein diameter (11.5 [10.0–14.8] mm vs 10.0 [9.3–11.8] mm, P =.034) at thirty‐day follow‐up. However, CAVI had no significant impact on TR, cardiac function, and morphology. Conclusions: Caval valve implantation significantly reduced systolic reflux into the hepatic veins but was not associated with an improvement in cardiac function, morphology, or TR severity. [ABSTRACT FROM AUTHOR]

Level III-IV robot-assisted inferior vena cava (IVC) thrombectomy (RA-IVCT) has been reported in limited series. To report our initial series of level III-IV RA-IVCT with step-by-step procedures and 1-yr outcomes. From November 2014 to January 2018, 13 patients with level III-IV IVC tumor thrombi underwent RA-IVCT with a minimum of 1-yr follow-up. Level III RA-IVCT requires liver mobilization and clamping of first porta hepatis (FPH), and suprahepatic and infradiaphragmatic IVC. Level IV RA-IVCT requires establishment of cardiopulmonary bypass (CPB). Thoracoscopy-assisted thrombectomy was performed for the intra-atrium part of the thrombus under CPB. Infradiaphragmatic RA-IVCT was completed in a manner similar to that of level III RA-IVCT. Detailed techniques were described for various scenarios. Baseline and perioperative outcomes were reported, and descriptive statistical analysis was performed. Median operative time was 465 (interquartile range [IQR]: 338–567) min. Median estimated intraoperative blood loss was 2000 (IQR: 1000–3000) ml. The rates of intraoperative blood transfusion and postoperative transformation to the intensive care unit ward were 92.3% and 100%, respectively. Median FPH blocking time was 40 (IQR: 25–60) min and the CPB time was 72 (IQR: 51–87) min. Three cases had grade IV complications, including two vascular injuries that were treated with intraoperative endoscopic sutures and one perioperative death. The perioperative mortality rate was 7.7%. During an 18-mo follow-up, two patients died and one patient progressed. Although the risks involved are high, level III-IV RA-IVCT is feasible and serves as an alternative minimally invasive method for selected patients. It also requires more complex techniques and multidisciplinary cooperation. We studied the treatment of patients with level III-IV inferior vena cava (IVC) tumor thrombi using a robotic approach. This technique was feasible for well-selected patients. However, level III-IV robot-assisted IVC thrombectomy requires more complex techniques and multidisciplinary cooperation. Although the risks involved are high, level III and IV robot-assisted inferior vena cava thrombectomy (RA-IVCT) is feasible. It provides an alternative minimally invasive method for well-selected patients. Level III and IV RA-IVCT required more complex techniques and multi-disciplinary cooperation. [ABSTRACT FROM AUTHOR]

The present study aimed to develop an accurate preoperative scoring system to predict the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy. The clinical data of 123 patients with renal cell carcinoma with renal vein or inferior vena cava tumour thrombus admitted to the Department of Urology at Peking University Third Hospital between January 2015 and May 2018 were retrospectively analysed. Univariate and multivariate regression analyses were used to create the scoring system with an emphasis on the area improvement under the receiver operating characteristic curve. A total of 58 (47.2%) patients underwent complete laparoscopic surgery, 56 (45.5%) underwent complete open surgery and 9 (7.3%) underwent laparoscopic conversion to open surgery. The final multivariable model included the following three factors: Clinical node stage (P=0.030), Mayo classification (P<0.001) and tumour diameter (P=0.001). These three variables were then used to construct the score system named Peking University Third Hospital Laparoscopic Probability (PKUTHLP), which ranges from 0–5. The proportion of patients undergoing laparoscopic surgery for each level of the PKUTHLP score were as follows: 0 (n=20), 100%; 1 (n=34), 67.6%; 2 (n=21), 33.3%; 3 (n=21), 19.0%; 4 (n=23), 17.4%; and 5 (n=4), 0.0%. Overall, the PKUTHLP score accurately predicted the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy; however, prospective validation of the PKUTHLP scoring system is required. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic major hepatectomy is a technically challenging procedure requiring a steep learning curve. The liver hanging maneuver is a useful technique in liver resection, especially for large or invasive tumors, a relative contraindication of the laparoscopic approach. Therefore, this study aimed to evaluate the learning curve for laparoscopic major hepatectomy using the liver hanging maneuver and extended indications.Methods: Patients who underwent laparoscopic major hepatectomy using the liver hanging maneuver by a single surgeon from January 2013 and September 2018 were retrospectively reviewed. Our hanging technique involves placing the hanging tape along the inferior vena cava for right-sided hepatectomy or the ligamentum venosum for left-sided hepatectomy. The upper end of the tape was placed at the lateral side of the major hepatic veins. The learning curve for operating time and blood loss was evaluated using the cumulative sum (CUSUM) method.Results: Among 53 patients, 18 underwent right hepatectomy, 26 underwent left hepatectomy, and 9 underwent right posterior sectionectomy. CUSUM analysis showed that operative time and blood loss improved after the 30th laparoscopic major hepatectomy. The 53 consecutive patients were divided into two groups (early, patients 1-30; late, patients 31-53). The median operative time was lower in the late group, but the difference was not statistically significant (270 vs. 245 min, p = 0.261). The median blood loss was also significantly lower in the late group (350 vs. 150 ml, p < 0.001). Large tumors (measuring > 10 cm) and tumors in proximity to major vessels were significantly higher in the late group (0 vs. 17.4%, p = 0.018; 3.3 vs. 21.7%, p = 0.036; respectively).Conclusion: This study shows that laparoscopic major hepatectomy using the modified liver hanging maneuver has a learning curve of 30 cases. After procedure standardization, the indications have gradually been extended to large or invasive tumors. [ABSTRACT FROM AUTHOR]

Purpose: Infrahepatic inferior vena cava (IIVC) clamping is beneficial for reducing the amount of bleeding during hepatic surgery, although the associated systemic circulatory deterioration is noticeable. The relationship between changes in the degree of IIVC clamping and postoperative renal function was retrospectively evaluated. Methods: A total of 59 patients who underwent elective hepatic surgery with surgical IIVC clamping in the two years were analyzed. In 2016, constant 80% clamping of the IIVC was performed (29 cases), and in 2017, hemodynamically adjusted IIVC clamping was performed (30 cases). Intraoperative parameters, including total blood loss and number of blood transfusions, were examined. The use of each vasoactive agents was analyzed. Renal function in the acute postoperative phase was evaluated using serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) values. Results: Comparison of the two groups showed that bolus doses of both ephedrine and phenylephrine were significantly higher in the 2016 group (P = 0.0221, 0.0017). Continuous doses of dopamine were significantly higher in the 2016 group, while those of noradrenaline were not. Postoperative serum Cr levels relative to baseline (%) were significantly higher in the 2016 group immediately after surgery and on postoperative day (POD) 1 (P = 0.0143, 0.0012). Postoperative eGFR relative to baseline (%) was significantly higher in the 2016 group immediately postoperatively and on PODs 1 and 2 (P = 0.0042, 0.0003, 0.0382). Conclusion: Hemodynamically adjustable IIVC clamping might be superior to uniformly fixed clamping in preserving renal function without compromising the desired effect on hemostasis. [ABSTRACT FROM AUTHOR]

Background: The surgical treatment of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. In the current study, the authors have reported their surgical outcomes and experience with en bloc retroperitoneal laparoscopic radical nephrectomy (LRN) with inferior vena cava (IVC) thrombectomy for patients with RCC with level 0 to II VTT.Methods: A retrospective review of the clinical records of 78 patients who underwent retroperitoneal LRN with IVC thrombectomy from March 2015 to September 2018 was performed. The surgical procedures included establishing the retroperitoneal space, ligating and severing the renal artery, clamping the renal vein and IVC, incising the IVC, and placing the renal and tumor thrombus en bloc into a retrieval bag.Results: According to the Mayo classification, the tumor thrombus was level 0, I, and II, respectively, in 28 patients, 27 patients, and 23 patients. The median operative time, estimated blood loss, and postoperative hospital stay were 256 minutes, 400 mL, and 8 days, respectively. A total of 67 patients were not converted to open surgery. No patient died during surgery, and no tumor embolization occurred. Thirteen patients experienced complications. The pathological reports indicated clear cell RCC in 70 patients and other RCC in 8 patients. The median follow-up was 14.5 months, and 61 patients were alive at the time of last follow-up.Conclusions: En bloc retroperitoneal LRN with IVC thrombectomy is a challenging but feasible procedure for experienced surgeons in patients with RCC with level 0 to II VTT. [ABSTRACT FROM AUTHOR]