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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]

Wilms tumor (WT) is the most common kidney tumor in pediatric patients. Intravascular extension of WT above the level of the renal veins is a rare manifestation that complicates surgical management. Patients with intravascular extension are frequently asymptomatic at diagnosis, and tumor thrombus extension is usually diagnosed by imaging. Neoadjuvant chemotherapy is indicated for thrombus extension above the level of the hepatic veins and often leads to thrombus regression, obviating the need for cardiopulmonary bypass in cases of cardiac thrombus at diagnosis. In cases of tumor extension to the retrohepatic cava, neoadjuvant therapy is not strictly indicated, but it may facilitate the regression of tumor thrombi, making resection safer. Hepatic vascular isolation and cardiopulmonary bypass increase the risk of bleeding and other complications when utilized for tumor thrombectomy. Fortunately, WT patients with vena caval with or with intracardiac extension have similar overall and event-free survival when compared to patients with WT without intravascular extension when thrombectomy is successfully performed. Still, patients with metastatic disease at presentation or unfavorable histology suffer relatively poor outcomes. Dedicated pediatric surgical oncology and pediatric cardiothoracic surgery teams, in conjunction with multimodal therapy directed by a multidisciplinary team, are preferred for optimized outcomes in this patient population. [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]

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]

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]

The perforation of the duodenum is a rare complication of inferior vena cava (IVC) filter placement. The aim of this report is to highlight the importance of high clinical suspicion in patients with a history of IVC filter placement and non-specific abdominal pain. This report presents a case of a 62-year-old male with 8 years of right upper quadrant abdominal pain, who had a history of multiple deep vein thrombosis with IVC filter placement. Upper gastrointestinal endoscopy and angiotomography were used for diagnosis. An exploratory laparotomy was performed for removal of the IVC filter and repair of the vena cava and duodenum. The patient made satisfactory recovery and was discharged from the hospital a few days later. This case highlights the importance of timely diagnosis and treatment to reduce the risk of morbidity and mortality. It also suggests that patients with this complication may have a favorable outcome if the diagnosis is made early and appropriate surgical management is provided. [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]

Background: To explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombus.Method: We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released.Result: There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 min, with an average of (6.8 ± 3.2) minutes. The mean time of IVC occlusion was (19.4 ± 4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ± 21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ± 144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease.Conclusion: This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus. [ABSTRACT FROM AUTHOR]

Background: Retrohepatic inferior vena cava (RIVC) resection without reconstruction in ex vivo liver resection and autotransplantation (ERAT) for advanced alveolar echinococcosis (HAE) is unclear.Methods: This is a retrospective study of consecutive patients referred to our hospital from 2014 to 2018. Depending on the presence of a rich collateral circulation and stable blood volume in ERAT, patients did not rebuild the RIVC. Then, patients were selected some appropriate revascularization techniques for the hepatic and renal veins. Finally, all ERAT procedures were completed, and short- and long-term outcomes were observed.Results: Five advanced HAE patients underwent ERAT without RIVC reconstruction. One patient died of circulatory failure 1 day after surgery. Another four patients, with a median follow-up duration of 18 months (range, 10-25 months), demonstrated normal liver and kidney function, no thrombosis and no HAE recurrence.Conclusions: Through the long-term results of ERAT, the pros and cons of not reconstructing the RIVC need to be re-examined. In cases with a rich collateral circulation, the RIVC cannot be reconstructed. However, in cases requiring the resection of multiple organs, RIVC without reconstruction was prudential. [ABSTRACT FROM AUTHOR]

Purpose: Currently, data surrounding predicting difficulty of IVC filter retrievals are heterogenous and conflicting. We aimed to identify which of many variables associated with IVC filters is a risk for procedural difficulty.Materials and Methods: This study retrospectively reviewed 6 years of IVC filter retrievals at a tertiary center identifying 356 consecutive retrievals. A difficult retrieval was defined as any case where the fluoroscopy time exceeded 7 min, an advanced technique was required, the retrieval attempt failed and required an additional attempt or was left permanent, or there was major complication such as IVC filter fracture/migration/vessel injury.Results: There were 105 filter retrievals defined as difficult (29.5%). Univariate analysis showed significantly increased risk for retrievals with an embedded top. Multivariate analysis assessed the association between dwell time, tilt, age, non-hooked filters, leg penetration and difficult retrieval. This showed a significant increase in the difficulty of retrieval for filters tilted between 5° and 15° (odds ratio 2.38, p < 0.001), for filters tilted more than 15° (odds ratio 7.91, p < 0.001), and dwell time greater than 6 months (odds ratio 2.06, p = 0.033). No significant increase in difficulty was seen with filters with a dwell time of less than 6 months, leg penetration, non-hooked filters, or with increasing patient age.Conclusions: Identifying these risks in patients in advance of the procedure allows appropriate planning and improved workflow efficiency. [ABSTRACT FROM AUTHOR]

Background: Oblique lateral interbody fusion surgery has become increasingly popular for lumbar degenerative diseases. The oblique corridor is between the psoas muscle and the retroperitoneal vessels, and its use could result in decreased tissue trauma, minimal blood loss, and short operation times. Patients who undergo oblique lateral interbody fusion surgery are always placed in the right lateral position to avoid damage to the inferior vena cava, which is typically a right-sided vessel. There is a substantial risk of vascular injury during the operation if there are anatomical variations in the vessels.Case Presentation: A 77-year-old man, of the Han nationality, with lumbar spinal stenosis underwent stand-alone oblique lateral interbody fusion surgery. Transverse magnetic resonance imaging of the lumbar spine indicated that his inferior vena cava was left-sided. A three-dimensional reconstructed image of abdominal computed tomography angiography showed that the inferior vena cava was located on the left side. Finally, the surgeon decided to change the position of our patient from a right lateral position to a left lateral position before the surgery.Conclusions: To date, this is the first reported case where a patient underwent oblique lateral interbody fusion surgery in a left lateral decubitus position due to a left-sided inferior vena cava. This case demonstrates that carefully reading radiological results is important for operation planning and avoiding anatomical complications. [ABSTRACT FROM AUTHOR]

Background: Both surgery and external‐beam radiotherapy are effective treatments for hepatocellular carcinoma (HCC) patients with inferior vena cava/right atrium (IVC/RA) tumor thrombi. At present, it is not clear which modality is more suitable. We therefore compared outcomes between surgery and radiotherapy for these patients. Methods: We retrospectively reviewed 108 HCC patients with IVC/RA tumor thrombi who were referred for surgery (n = 51) and external‐beam radiotherapy (n = 57) at three institutions. Different surgical methods were selected according to the classification of the tumor thrombus. Radiotherapy was designed to focus on primary intrahepatic tumors and tumor thrombi. Predictors of time to progression (TTP) were identified by using univariate and multivariate analyses. Results: The median TTP was significantly longer in the radiotherapy group than in the surgery group (5.0 months vs 4.2 months; P = 0.010). The multivariate analysis revealed that independent factors predicting shorter TTP were treatment with surgery (HR = 0.577; 95% CI, 0.385–0.865; P = 0.008) and intrahepatic tumor size larger than 10 cm (HR = 0.561; 95% CI, 0.342–0.919; P = 0.022). The median survival times for the radiotherapy and surgery groups were 12.8 and 14.5 months, respectively; the two groups did not have a significant difference in survival (P = 0.466). Conclusions: For HCC patients with IVC/RA tumor thrombi, treatment with external‐beam radiotherapy and intrahepatic tumor size smaller than 10 cm may predict longer TTP. Compared with complicated surgery, radiotherapy, as a noninvasive treatment modality, may be more likely to be accepted. [ABSTRACT FROM AUTHOR]

Background Inferior vena cava agenesis (IVCA) is a rare anomaly that presents in 5% of cases of unprovoked lower extremity deep venous thrombosis (DVT), mostly bilateral and significantly under the age of 30 years. Conventional treatment with systemic anticoagulation may not be sufficient in limb-threatening stages. Catheter-directed thrombolysis (CDT) could be the modality of choice in this condition. Aim The purpose of this case series is to report our experience with CDT to manage patients with congenital absence of inferior vena cava presented with bilateral acute iliofemoral venous thrombosis. Patients and methods From February 2015 to March 2017, three patients were referred to Ain Shams University Hospitals and underwent CDT to treat bilateral iliofemoral DVT with IVCA after failure of treatment with systemic anticoagulation. Periprocedural and postprocedural details were recorded. Follow up with clinical examination and duplex ultrasound was performed regularly for 2 years. Results The mean procedural time was 52 h. Technical and clinical success were achieved in all the procedures. No further balloon angioplasty or stent placement was required. No major bleeding occurred. None of the patients had symptoms of pulmonary embolism. The mean postoperative hospital stay was 7 days. During the follow up, none of the patients developed recurrent DVT. Duplex ultrasound showed a patent deep system with only one patient who got unilateral femoral vein reflux, while computed tomography venography showed patency of pelvic and abdominal collaterals in all patients. Conclusion CDT is a safe and effective modality of treatment for patients with bilateral acute iliofemoral DVT associated with IVCA. It helps to reestablish the patient's baseline venous drainage for limb salvage, rapid symptomatic relief, and prevention of postthrombotic syndrome. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous transluminal balloon angioplasty (PTA) is the main treatment option for Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction. However, IVC rupture caused by PTA has never been reported.Materials and Methods: Between August 2004 and December 2016, a consecutive cohort of 617 BCS patients with obstructed IVC who underwent PTA with or without stent placement were reviewed retrospectively to identify IVC rupture. Pre- and post-procedural imaging data, clinical and procedural technical data were analyzed.Results: Of the 617 BCS patients, five patients had IVC rupture caused by PTA (0.81%). Four of these patients had retroperitoneal, intra-hepatic IVC rupture without extravasation into abdominal cavity which was successfully managed conservatively. One patient had supra-hepatic IVC rupture into the pericardial cavity which was surgically treated.Conclusion: IVC rupture is a rare complication of PTA treatment of BCS and most commonly located at the intra-hepatic IVC caused by oversized balloons which does not require additional treatment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate contemporary oncological outcomes and long‐term survival in patients undergoing surgery for urological tumours involving the peridiaphragmatic inferior vena cava up to the level of the right atrium. To apply prognostic factors developed for metastatic renal cancer to patients with very‐high‐risk but apparently localized tumours, and develop a scoring system. Patients and Methods: A retrospective cohort study of 54 patients referred between December 2007 and April 2018 to a single surgical and oncological team was conducted. Electronic patient records were used to obtain peri‐operative data and oncological follow‐up. For operated patients lost to follow‐up, survival data were obtained from primary care physicians. We used Kaplan–Meier curves to estimate overall survival (OS) and disease‐free survival. For the subgroup undergoing curative surgery (n = 32) the prognostic value of a renal cancer score developed at Guy's Hospital using five of the six criteria in the International Metastatic Renal Cell Carcinoma Database Consortium prognostic model (one point for each of anaemia, neutrophilia, thrombophilia, hypercalcaemia and Karnofsky performance status <80), in order to be relevant for M0 disease, was assessed using the log‐rank test. Results: The median (interquartile range [IQR]) OS of the whole cohort was 29 (11–57) months. The median (IQR) survival of the curative subgroup (n = 32) was 32 (16–57) months, vs 11 (4–upper limit not reached) months for the cytoreductive subgroup (n = 13; P = 0.14). The median (IQR) follow‐up time was 14 (1–65) months for patients alive at analysis. Disease‐free survival in the curative subgroup was 10 (6–30) months. The median (IQR) OS by risk category for curative cases, as defined by the Guy's renal cancer score, was not reached in the favourable risk group (score = 0 points) because there were no patient deaths, 43 (30–61) months in the intermediate‐risk group (score = 1 point), and 18 months (11–32) months in the poor‐risk group (score ≥ 2 points; P = 0.005). Conclusion: A median survival of 29 months appears to justify this type of surgery. A prognostic model, the Guy's renal cancer score, using five readily available clinical measures, appears promising in patients with very‐high‐risk locally advanced tumours. [ABSTRACT FROM AUTHOR]

Aim: To evaluate individualized treatment strategy (ITS) and long‐term outcomes of endovascular treatment of Budd‐Chiari syndrome (BCS) with obstructed inferior vena cava (IVC) based on different degrees of hepatic vein (HV) involvement. Methods: From January 2006 to June 2017, 456 consecutive patients with BCS with obstructed IVC underwent endovascular treatment with ITS. All patients received IVC recanalization. Then, 426 patients with at least one patent HV received no additional treatment. Twenty‐fivepatients with membranous or segmental occlusion of HVs underwent HV recanalization and for the remaining five patients with diffuse HVs occlusion, a transjugular intrahepatic portosystemic shunt (TIPS) was performed. Results: The endovascular treatment was technically successful in 455 of the 456 patients (99.8%). The complication rate was 5.0% (23/456), with major complications in 13 patients (2.8%) and minor complications in 10 patients (2.2%). Median follow‐up time was 60.5 months (range, 4‐120 months). The cumulative 1‐, 2‐, 5‐ and 10‐year primary vessel patency rates were 93.6%, 89.9%, 80.5% and 74.3% respectively and the cumulative 1‐, 2‐, 5‐, 10‐ year secondary patency rates were 99.8%, 99.8%, 98.2% and 97.2% respectively. The cumulative 1‐, 2‐, 5‐ and 10‐year survival rates were 98.4%, 95.8%, 91.2% and 76.5% respectively. Illness duration and decreased serum albumin were independent predictors of survival. Conclusion: The ITS for Asian BCS with obstructed IVC and varying degrees of HV involvement appears to be effective and with good long‐term outcomes. [ABSTRACT FROM AUTHOR]

Injury of the pancreaticoduodenal complex near the ampulla poses challenges for intra-operative decision making in an emergency setting. We present a rare case of penetrating abdominal trauma which resulted in injury to the second part of duodenum, intra-pancreatic common bile duct, and inferior vena cava. Inferior vena cava repair, pancreas sparing duodenal resection, Roux-en-Y hepaticojejunostomy, and gastrojejunostomy were performed with good postoperative outcomes. Technical aspects of the procedure and nuances in decision making are discussed along with relevant literature. [ABSTRACT FROM AUTHOR]

Purpose: Several vascular measurements in computed tomography (CT) were reported to be indicators of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) patients. We evaluated the usefulness of these parameters as predictors of postoperative mortality in lung cancer patients with IIP. Methods: This retrospective study was performed on 1888 patients. The following CT findings were evaluated: diameter of the main pulmonary artery, ascending aorta, and the short axis of the inferior vena cava (IVC). Univariate and multivariate analyses were conducted to determine predictors of surgical mortality. Results: In the IIP patients, the 90-day mortality was 0.8%, and the 2-year mortality was 5.8%. Regarding the 90-day mortality in patients with IIP, a multivariate analysis revealed a short axis of IVC > 21 mm [odds ratio (OR) 6.4, p < 0.01) and the risk score reported by Japanese Association for Chest Surgery (JACS) (OR 1.4, p = 0.01) as independent predictors. Regarding the 2-year mortality in patients with IIP, a multivariate analysis revealed IVC > 21 mm (OR 2.3, p < 0.04), %VC < 80% (OR 2.4, p = 0.02), and pathological cancer stages II and III vs. I (OR 7.2, p < 0.001) as independent predictors. Conclusions: Enlargement of the IVC as measured by CT was a significant predictor of mortality after surgery for lung cancer with IIP patients. [ABSTRACT FROM AUTHOR]

Purpose: To report the long-term results of endoluminal sharp recanalization of occluded inferior vena cava (IVC) in patients with the Budd-Chiari syndrome (BCS).Patients and Methods: Seventy-two consecutive patients with BCS and IVC occlusion underwent endoluminal recanalization of the IVC occlusion during a 6-year period. BCS with occlusive IVC was detected by reviewing patient history and color Doppler ultrasonography. Data on technical success, morbidity, mortality, complications, and color Doppler sonographic outcome were collected and analyzed.Results: Seventy-seven recanalizations were performed in 72 patients. Technical success (patent IVC with good blood flow) was achieved in 70 (97.4%) patients. No perioperative death was observed. Six complications were found during recanalization, and 10 complications were found for total interventional procedures. The complication rates were 7.8% and 7.3% for recanalization and total procedure, respectively. Bleeding of access veins was the most common complication, and 2 patients showed slight rupture of IVC. The postoperative IVC diameter and blood speed of IVC increased significantly. Fifty-seven patients (79.2%) were clinical cured, and 2 patients (2.8%) showed no improvement. The 1-year, 3-year, and 5-year primary patency rates were 92.5%, 86.8%, and 77.3%, respectively. The second patency rates were 100.0%, 97.8%, and 91.8% for 1, 3, and 5 years, respectively. There were 2 deaths during follow-up.Conclusion: Endoluminal sharp recanalization of occluded IVC in patients with BCS is safe and effective with good long-term outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this work is to assess the predictive value, for fluid responsiveness (FR), of the inferior vena cava distensibility index (IVC-DI) and internal jugular vein distensibility index (IJV-DI) in pediatric surgical patients. Material and Methods: Prior to being placed under general anesthesia, 24 surgical patients were enrolled. Baseline parameters were recorded with the patient in the semirecumbent position (Stage 1). Next, the passive leg raising (PLR) maneuver was carried out and a second measurement was recorded (Stage 2). Patients with an increase in the cardiac index (CI) of >10%, induced by PLR, were considered to be responders (R), otherwise they were classified as nonresponders (NR). At both stages, CI and DI of the IVC and IJV were measured. Results: Responders had higher IVC-DI and IVJ-DI than NR in stage 1 (both p <.001). In stage 2, IVC-DI and IJV-DI were not different in R and NR groups (p =.164, p =.201). Utilizing cut-off values of > 22.7% for IVC-DI and > 25% for IJV-DI, these parameters had positive correlation coefficients, both in R and NR of, respectively, 0.626 and 0.929. Conclusions: The IVC-DI predicts FR in anesthetized pediatric patients and correlates well with the IJV-DI; both may be used as prediction markers of FR in children. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the utility of ultrasonographic measurement of the diameter of the inferior vena cava (IVCD) and abdominal aorta (AAD) for assessing volume status. Material and methods: This was a prospective, observational study. A total of 23 volunteers participated in the study. Each participant was selected randomly. All participants completed the 2016 Kaunas Marathon. Participants filed out a brief survey about their fluid intake (in standardised glasses) in the 24h before the race and during the race. Participants underwent ultrasound measurements 10-40min before the start of the race and 3-15min after finishing the race. To visualize respiratory variation, M-mode was used, with the beam crossing the IVCD 2cm from the right atrium. The AAD was measured 1cm above the celiac trunk. IVCD in expiration (IVCDexp)/AAD was calculated by dividing the value of IVCDexp by the value of AAD. The findings were compared with difference in body mass index. Results: The mean weight lost after the marathon was 2.93kg (p < 0.001). Mean IVCD in inspiration (IVCDins) after the run was lower by 0.39cm (p < 0.001) then before the run. Mean IVCDexp/AAD after the run was 0.24cm lower than before the run (p = 0.03). Before and after the marathon, there was a statistically significant negative correlation in weight difference, with mean IVCDexp difference (p = 0.047). There was no statistically significant difference in caval index before and after running. Conclusion: Ultrasonographic assessment of IVCDexp could be useful in the evaluation of volume status. [ABSTRACT FROM AUTHOR]

Advanced techniques have been described to remove embedded inferior vena cava (IVC) filters including the loop snare and modified loop snare (Hangman) techniques. Retrieval of embedded filters have been associated with higher rates of complications including IVC injury and stenosis. We report two challenging embedded retrievals complicated by IVC injury and haemorrhage. Haemostasis was successfully achieved with prolonged balloon tamponade, suggesting that injury to the IVC during filter retrieval may not need urgent surgery. However, both patients received short-term complications related to caval thrombosis and patients in this cohort should be closely observed after retrieval. These cases support rigorous attention to filter indication and follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of percutaneous transhepatic route creation for hepatic vein (HV) angioplasty in Budd-Chiari syndrome (BCS).Patients and Methods: Between April 2012 and August 2016, a total of 19 BCS patients underwent percutaneous transhepatic route creation for HV angioplasty after transvenous catheterization failure in this study. Color Doppler ultrasonography was required in all patients after admission and during follow-up. Data were retrospectively collected, and follow-up observations were performed.Results: Technical and clinical success was achieved in 18 patients. Except for 1 failure of route creation, 19 routes were successfully created in 18 patients, with a technology success rate of 95.0%. Twenty-two balloon angioplasties were performed in 18 patients, with a mean balloon diameter of 13.6 ± 0.5 mm. Blood pressure and length of occlusive HV decreased significantly, and blood flow velocity and diameter of HV increased significantly after procedure. Abdominal distension/pain and ascites decreased significantly after procedure. One procedure-related death occurred, who died of gastrointestinal bleeding 6 days later. Except for the failure case, the rest of 18 patients were successfully followed up. The remaining 18 patients survived during follow-up, with a 5-year survival rate of 94.9%. One patient had a restenosis of HV after 47 days, and had undergone successful dilation. The 5-year primary and second patency rates were 94.1% and 100%, respectively.Conclusion: Percutaneous transhepatic route creation is safe and effective for HV angioplasty, and can be used to treat BCS patients after transvenous catheterization failure. [ABSTRACT FROM AUTHOR]

Abstract Background Robot-assisted retrohepatic inferior vena cava (IVC) thrombectomy (RA-R-IVCTE) has been reported only for limited series. Objective To describe in detail the techniques for RA-R-IVCTE with regard to the relationship of a proximal thrombus to either the first porta hepatis (FPH) or second porta hepatis (SPH). Design, setting, and participants From May 2013 to July 2016, 22 patients with R-IVC tumor thrombi were admitted to our hospital. Surgical procedure RA-R-IVCTE was performed using the Rummel tourniquet technique. For a proximal thrombus inferior to the FPH, we ligated some short hepatic veins (SHVs; typically 1–3). For a thrombus between the FPH and SPH, we mobilized the right lobe of the liver from the IVC by ligating additional SHVs. For a thrombus near or above the SPH but below the diaphragm, we mobilized both the right and left lobes of the liver to obtain high proximal control of the suprahepatic and infradiaphragmatic IVC, and simultaneously clamped the FPH. Measurements Detailed techniques were described for various scenarios and perioperative outcomes were recorded. Results and limitations The median operation time was 285 min (interquartile range [IQR] 191–390). Intraoperative estimated blood loss was 1350 ml (IQR 1000–2075 ml). Some 63.6% of patients required an intraoperative blood transfusion and 68% were transferred to the intensive care unit after surgery. Grade IV complications developed in five cases. Vascular injuries (4 cases) were treated with intraoperative endoscopic sutures. An intestinal fistula was found on postoperative day 7 in one case; treatment with gastrointestinal decompression and drainage resolved the condition by 1 mo. Conclusions Even though the risks involved are high, RA-R-IVCTE is feasible for selected patients. The FPH/SPH is an important boundary landmark for RA-R-IVCTE. The location of proximal IVC tumor thrombi in relation to the FPH or SPH should determine the technique used. Patient summary Robot-assisted thrombectomy for retrohepatic inferior vena cava tumor thrombus is feasible in selected patients. Take Home Message Robot-assisted retrohepatic inferior vena cava thrombectomy (RA-R-IVCTE) is feasible for selected patients. The first/second porta hepatis (FPH/SPH) is an important boundary landmark for RA-R-IVCTE. Different IVC tumor thrombus locations in relation to the FPH or SPH require different techniques. [ABSTRACT FROM AUTHOR]

The prognosis of hepatocellular carcinoma (HCC) patients with tumor thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is extremely poor. We reviewed the recent surgical treatments and outcomes of this form of advanced HCC. TT is classified into three types according to its anatomic location relative to the heart: the inferior hepatic type (type I), where the TT is in the IVC below the diaphragm; the superior hepatic type (type II), where the TT is in the IVC above the diaphragm, but still outside the RA; and the intracardiac type (type III), where the TT is above the diaphragm and has entered the RA. Type I can be treated relatively easily by standard radical hepatectomy. For type II, the intrathoracic IVC is approached via the abdominal cavity and an incision in the diaphragm with total hepatic vascular exclusion (THVE). For type III, hepatectomy plus thrombectomy is generally performed under cardiopulmonary bypass. If the TT is only just inside the RA, THVE can be performed by mobilizing the liver caudally. The median overall survival of HCC patients with TT in the IVC or RA, who undergo curative resection, is 19.0-30.8 months. As postoperative recurrence is likely to develop, even after curative surgery, effective postoperative adjuvant chemotherapy is required. [ABSTRACT FROM AUTHOR]

Anomalous drainage of the inferior vena cava into the left atrium is a rare congenital vascular disorder. It can occur with atrial septal defect, anomalous pulmonary venous drainage, and pulmonary arteriovenous fistula. Hereby we describe the computed tomography (CT) findings of a rare combination of drainage of the inferior vena cava associated with atrial septal defect and partial anomalous pulmonary venous return. CT angiography is useful for early detection of this combined anomaly and for proper surgical planning. [ABSTRACT FROM AUTHOR]

Introduction: The authors of this paper assessed the surgical management and outcome of renal cancers when tumor thrombus extended into the inferior vena cava (IVC). Methods: From 2000 to 2015, 46 radical nephrectomies were performed on patients with tumor thrombus in the IVC. The mean age of the patients was 60 ± 11 years. Radical nephrectomy and thrombectomies were performed in a single session. There were 18 level-IV, 23 level-III, and 5 level-II tumor thrombi. The operations were performed using cardiopulmonary bypass in 14 patients, while deep hypothermic cardiac arrest was carried out in 4 cases. Results: The mean size of the tumors was 9.4 ± 3.5 cm. Histology showed the tumor stages to be pT3b in 21cases, pT3c in 22, and pT4 in 3 patients. The mean follow-up period of the patients was 3.6 ± 3.0 years. During the follow-up period, local recurrence was observed in 7 patients, while distant metastases occurred in 8 cases. The median time to progression was 37 ± 27 months. The 5-year overall survival was 43.7%. Conclusions: Radical nephrectomy and thrombectomy provided reasonable long-term survival for patients with renal cancer and IVC thrombus. However, tumor progression was detected in 41.6%. The presence of tumor thrombus had a negative effect on tumor progression and survival. [ABSTRACT FROM AUTHOR]

The agenesis of the hepatic section (absence of hepatosubcardinal anastomosis) of the inferior vena cava associated with its duplication and drainage through the hemiazygos vein is a rare vascular condition coincidentally diagnosed in a young patient with unprovoked deep vein thrombosis. Purpose: we report the case of a young man with no personal or family history of thrombosis, examined on grounds of acute abdomen suspicion and diagnosed with organized primary idiopathic thrombosis of the superior mesenteric vein, due to inferior vena cava abnormalities. Materials and methods: the 26 year-old patient with stage VI CEAP chronic venous insufficiency, leg lymphedema and recently occurred acute abdominal pain was examined by simple thoracic and abdominal X-ray and thoracic abdominal- pelvic computerized tomography scan with contrast medium and by assessment of his inherited vein thromboembolism risk factors. Results: the CT scan revealed segmental thrombosis of the superior mesenteric vein and jejunal vein ischemia associated with several abnormalities of the duplicated inferior vena cava (with congenital absence of its hepatic section). The inherited thrombophilia results were negative and his evolution under symptomatic and anticoagulant therapy (continued in an outpatient clinic, designed to prevent vein thrombosis recurrence) was positive. Conclusions: splanchnic deep vein thrombosis, which is rarely associated with segmental hypo- or agenesis of the inferior vena cava, sometimes allows a coincidental vein abnormality diagnosis. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) variants are rare and are usually detected incidentally. Even though, these variants are by themselves asymptomatic, they can have important clinical, radiological, and surgical implications. In this pictorial essay, we sensitize the reader to various IVC variants by presenting reports of actual patients. A succinct description of the embryological development of these anatomic variants is also provided. [ABSTRACT FROM AUTHOR]

Leiomyosarcoma of inferior vena cava (IVC) is a rare soft tissue tumour. Only 0.5% of all soft tissue sarcomas of adults and only 300 cases are reported till date. We describe our encounter with such a case where we were successful in radical excision of tumour with the use of vascular staplers on the IVC without compromising IVC lumen. Leiomyosarcoma of IVC is a rare entity, and laparoscopic excision of the tumour is possible in exophytic tumour. [ABSTRACT FROM AUTHOR]

The article discusses the study on the impact of inferior vena cava perforation based on filters. It details how the study was conducted which involved 391 cases of inferior vena cava perforation on an open, voluntary database in the U.S. The results reportedly revealed that poor quality vena cava perforation by filters have remained stable from January 2000 to June 2011 despite the growing number of complications reported.

Objective To assess the outcomes of inferior vena cava replacement with polytetrafluoroethylene expanded prosthesis in patients with renal cell carcinoma and caval thrombosis. Methods All patients who underwent radical nephrectomy with inferior vena cava replacement by polytetrafluoroethylene expanded prosthesis for renal cancer associated with inferior vena cava thrombosis and a suspicion of inferior vena cava wall invasion from January 2000 to June 2011 were considered for this study. Demographic data, postoperative course, graft patency and survival data were evaluated. Results A total of 26 patients (median age 59.5 years, range 19.9-85.6 years) were included in the analysis. The median tumor diameter was 10 cm (range 5-14 cm). Histological invasion of the wall of the inferior vena cava was found in 16 (61.5%) cases. The median follow up was 28 months (range 1-136). A graft thrombosis occurred in five (19.2%) patients within the first year. Four of these patients died before the end of the second year. Patency of the inferior vena cava graft at 6 and 12 months was 88% and 79%, respectively. Overall survival probability at 3 years was 64%. Conclusion Prosthetic replacement of the inferior vena cava can be carried out when invasion of the wall of the inferior vena cava is suspected. The postoperative complication rate in this subset of high-risk patients undergoing radical nephrectomy seems acceptable, and the patency of the prostheses is good in most of the cases. [ABSTRACT FROM AUTHOR]

Background: Resection of the inferior vena cava (IVC) is occasionally performed for patients with advanced malignancy in the retroperitoneum. In the current study, we assessed the oncological effectiveness of IVC resection combined with tumor resection. We also addressed peri- and postoperative complications associated with resection and reconstruction of the IVC. Methods: Between 1984 and 2011, a total of 23 patients underwent caval resection concurrently with retroperitoneal tumor excision. Primary tumor histology was renal cell carcinoma in 19 patients, metastatic germ cell tumor in 2, and leiomyosarcoma, and adrenal cancer in 1 patient each. Clinicopathological data from these patients were retrospectively reviewed. Results: IVC reconstruction was performed by direct suture in 11 patients, patch repair in 8 and graft replacement in 3 patients. Interruption of the IVC was performed in one patient. There was no lethal complication or pulmonary embolism. Intracaval thrombosis, although patent, was observed in four patients after surgery. All patients underwent infrarenal IVC reconstruction. The median follow-up was 12 months (range 1-121 months). Of the 20 patients without distant metastasis at the time of surgery, complete resection was achieved in 14, whereas 6 patients had positive margins. Although nine patients developed distant metastases postoperatively, there was no local recurrence. The overall survival, progression-free survival and cause-specific survival in those RCC patients without distant metastasis at the time of surgery were 56.1, 47.0 and 60.4 %, respectively, at 5 years. Conclusions: For advanced malignancies involving the IVC, resection is a safe and feasible procedure for selected patients. [ABSTRACT FROM AUTHOR]

This study reports on the frequency and management of aortocaval fistulas (ACFs) in our department between 1998 and 2009. Overall frequency of ACFs among ruptured abdominal aortic aneurysms was 5.5%. Patients presented with low back pain (92.8%), abdominal tenderness (78.6%), hemorrhagic shock (28.6%), congestive heart failure (21.4%), dyspnea (42.8%), and palpitations (57.1%). The most reliable clinical sign was the presence of palpable pulsating abdominal mass (92.8%). Other clinical findings included increased central venous pressure (21.4%), lower extremity edema (71.4%), hematuria (21.4%), and scrotal edema (14.3%). Diagnosis was established preoperatively in 85.7% and intraoperatively in 14.3% of cases. Surgery was successful in promptly improving clinical signs and symptoms. Mortality rate was 7.1%. After a mean follow-up of 18.5 months, all surviving patients remained free from complications. In conclusion, ACFs represent a life-threatening emergency for vascular surgeons but can be successfully managed. [ABSTRACT FROM PUBLISHER]

The article discusses the implications of radical nephrectomy with inferior vena cava (IVC) thrombectomy for post-operative nursing care. An overview of the radical nephrectomy with IVC thrombectomy is provided, along with the components of post-operative nursing care such as pain management and respiratory management. Also explored are post-operative complications associated with the surgical procedure.

Dissection of the inferior vena cava (IVC) is rare, with only a few published reports in the literature. It is usually associated with blunt abdominal injury or iatrogenic injury from a catheter manipulation. Venous dissections are rare due to lack of well-developed layers in the walls (intima, media and adventitia), low pressure in the venous system, and the absence of atherosclerotic changes. However, IVC dissection is associated with a high mortality rate due to the difficulty in diagnosis, technically difficult surgical repair, and associated solid organ injuries. We report a case of IVC dissection from a low-speed motor vehicle collision and discuss its imaging features. [ABSTRACT FROM AUTHOR]

Abstract: Background: Renal cell carcinoma (RCC) with a tumor thrombus extension into the inferior vena cava (IVC) demands aggressive surgical management. Objective: To evaluate the long-term survival in patients undergoing radical nephrectomy and IVC thrombectomy. Design, setting, and participants: We performed a retrospective analysis of 87 patients undergoing surgery between 1997 and 2008. The patients were grouped according to the extent of tumor thrombus, with level I involving the IVC at the level of the renal vein, level II being infrahepatic IVC, level III being intrahepatic IVC, and level IV being suprahepatic IVC or right atrium. Relevant clinical and pathologic data were analyzed. Measurements: Disease-free survival (DFS) and disease-specific survival (DSS) were studied. Results and limitations: The median follow-up was 22 mo, and 19, 14, 40, and 14 patients had level I, II, III, and IV IVC thrombus, respectively. Among patients with M0 disease, 22 developed metastases. The 5-yr DFS was 64% for all levels and 74%, 69.5%, 59.5%, and 58% for levels I, II, III, and IV, respectively. Of the level I group, 16% of patients died of disease compared to 57% of the level IV group. The 5-yr DSS for all levels was 46% and 71%, 48%, 40%, and 35% for levels I, II, III, and IV, respectively. Patients with level IV thrombus had a significantly lower 5-yr DSS compared to level I (p =0.03). However, when analyzed in two groups—supradiaphragmatic and infradiaphragmatic—there was no significant difference in DSS (P =0.14). On univariate analysis, metastasis at presentation, non–clear-cell histology, lymph node metastases, and higher nuclear grade were statistically significant prognostic factors influencing DSS. Only higher nuclear grade (p =0.03), metastasis at presentation (p <0.01), and non–clear-cell histology (p =0.03) were independent prognostic factors on multivariate analysis. Conclusions: Radical nephrectomy and IVC thrombectomy offer reasonable long-term survival. The level of tumor thrombus is not an independent prognostic factor. Distant metastasis at presentation, higher nuclear grade, and non–clear-clear cell histology are significant prognostic factors influencing DSS. [Copyright &y& Elsevier]

Abstract: Background: Ligation of the significantly injured infrarenal inferior vena cava (IVC) is an accepted practice in the setting of damage control surgery. This is a report of inpatient management, outcomes, and long-term follow-up in 25 patients after IVC ligation. Methods: The records of patients with injuries to the IVC treated in an urban level I trauma center from 1995 to 2008 were reviewed. Demographics, injury severity, and outcome data were recorded. In addition, outpatient records were reviewed and telephone interviews were conducted to assess for the presence and severity of long-term sequelae. Results: One hundred patients had IVC injuries, and 25 (25%) underwent ligation. Location of injury was infrarenal in 54 patients, suprarenal in 21, retrohepatic in 15, and suprahepatic in 10. Twenty-two of 54 (41%) injuries to the infrarenal IVC and 3 of 21 (14%) injuries to the suprarenal IVC were ligated. Patients who underwent ligation had a significantly higher Injury Severity Score (ISS) (22 vs 15, P < .001), a higher transfusion requirement (26 U vs 12 U, P < .001), a longer hospital length of stay (78 days vs 26 days, P = .02), a longer intensive care unit length of stay (24 days vs 9 days, P < .001), and a higher mortality (59% vs 21%, P < .001). Ten of 13 early survivors of infrarenal IVC ligation received early below knee fasciotomy. Three other patients with normal compartment pressures were treated expectantly without development of a compartment syndrome. The 1 survivor of suprarenal ligation had below knee fasciotomies and had normal renal function by 1 month post injury, despite an initial creatinine elevation from .7 mg/dL to 3.2 mg/dL. Ten (40%) patients with IVC ligation survived to hospital discharge (9 infrarenal, 1 suprarenal), and long-term follow-up data are available in 8 patients (7 infrarenal, 1 suprarenal). At an average of 42 months (11–117 months), no patient has significant lower extremity edema or dysfunction. Conclusions: (1) Ligation of the infrarenal IVC is an acceptable damage control technique, although it remains associated with a high mortality. Ligation of the suprarenal IVC may be done, if necessary, although few survivors of this technique exist. (2) Early fasciotomy is generally required, but occasional patients may be treated expectantly, based on measurements of compartment pressures. (3) Long-term sequelae in survivors of IVC ligation for trauma are rare. [Copyright &y& Elsevier]

Abstract: Background: Vena caval injury is a rare but serious complication of laparoscopic surgery, and often requires conversion to an open procedure. The current study investigated whether a vena caval injury could be repaired with a chitosan dressing laparoscopically. Methods: Six domestic swine were studied. A 4- to 5-mm circumferential incision was created in the inferior vena cava (IVC) and repaired laparoscopically with a chitosan dressing. Neither suture nor additional hemostatic techniques were used. The animals were killed at 30 minutes (n = 2) and at 1 week (n = 4) postoperatively for histopathological analysis. Results: All IVC injuries were successfully repaired laparoscopically using a single chitosan dressing application without recurrent hemorrhaging. Mean operative time was 6 minutes and the blood loss was approximately 55 mL. There was no evidence of clot formation in the repaired vessels. Histology showed that the chitosan dressing had partially degenerated into small particles with moderate chronic inflammatory response 1 week after repair. Conclusion: Use of the chitosan-based hemostatic dressing is a simple and reliable technique to control serious hemorrhage from IVC injury during laparoscopic surgery. [Copyright &y& Elsevier]

Introduction: Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor for which en bloc resection offers the only chance of cure. Due to its rarity, however, optimal strategies for the management of the primary tumor and subsequent recurrences are not well defined.Methods: We performed a retrospective review of patients who underwent surgical resection of IVC leiomyosarcoma. We evaluated clinical presentations, operative techniques, patterns of recurrence and survival.Results: From 1990 to 2008, nine patients (four females) were identified. Median age was 55 years (40-76). Presentations included abdominal pain (n = 5), back pain (n = 2), leg swelling (n = 4) and abdominal mass (n = 2). Pre-operative imaging studies showed tumor location to be from the right atrium to renal veins (n = 1), retrohepatic (n = 5), and from hepatic veins to the iliac bifurcations (n = 3). En bloc resection included right nephrectomy (n = 5), right adrenalectomy (n = 4), pancreaticoduodenectomy (n = 1), right hepatic trisectionectomy (n = 1) and right hemicolectomy (n = 1). The IVC was ligated in six patients, and a prosthetic graft was used for IVC reconstruction in three patients. Resection margins were negative in seven cases. Median length of stay was 12 days (range, 6-22 days). Major morbidity included renal failure (n = 1) and there was one post-operative mortality. Five patients had leg edema post-operatively, four of whom had IVC ligation. Median survival was 47 months (range, 1-181 months). Four patients had recurrence and the median time to recurrence was 14 months (range, 3-25 months). Two patients underwent successful resection of recurrence.Conclusions: Curative resection of IVC leiomyosarcoma can lead to long-term survival. However, recurrence is common, and effective adjuvant treatments are needed. In selected cases, aggressive surgical treatment of recurrence should be considered. [ABSTRACT FROM AUTHOR]

Aneurysms of the inferior vena cava (IVC) are extremely rare. To the best of our knowledge, only 29 cases of IVC aneurysms are published in literature. We present a new case of surgically treated symptomatic saccular aneurysm of the infrarenal IVC and review previously published cases. Following resection of the aneurysm and the thrombosed infrarenal IVC, the patient fully recovered. Thrombosed IVC aneurysm may mimic a retroperitoneal tumour. In some cases, CT and MRI findings may be equivocal. Surgical treatment is indicated in all symptomatic and low-risk asymptomatic cases. [ABSTRACT FROM AUTHOR]

Inferior vena caval (IVC) ligation during surgery is considered prohibitively risky. Most of the IVC ligations reported in the literature have been in the context of trauma damage control. There are only anecdotal reports in the literature of a successful elective ligation of the IVC in children. Records from a paediatric tertiary care centre were reviewed over a 20-year period to identify and evaluate patients who underwent an intentional ligation of the IVC during elective surgery. The reports from the literature of IVC ligations were reviewed. The physiologic and anatomic basis for the sequelae of IVC ligation was examined. Intentional ligation of the IVC was done in four patients. Apart from pedal oedema and ascites lasting for 1 and 9 months, respectively, in two of them, none of these patients had any long-term sequelae related to the ligation of their IVC. Adequate collaterals providing satisfactory drainage were demonstrated by Doppler studies postoperatively. We suggest that during surgery, when other options are absent, the IVC can be safely ligated in children, providing a therapeutic benefit to the patient. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical safety and efficacy of the TrapEase vena cava filter in a 4-year single center experience. Methods: The clinical and imaging data of 751 patients (384 men; mean age 64 years, range 16-99) who had a TrapEase inferior vena cava (IVC) filter placed between January 1, 2001, and December 31, 2004, were reviewed retrospectively. More than a third of patients (297, 39.5%) presented with pulmonary embolism (PE), 188 (25.0%) had deep vein thrombosis (DVT), 40 (5.3%) had both PE and DVT, and the rest (226, 30.1%) had other symptoms. Indications for filter placement were contraindication to anticoagulation (461, 61.4%), complication of anticoagulation (42, 5.6%), failure of anticoagulation (39, 5.2%), and prophylaxis (209, 27.8%). Filters were placed in the infrarenal (n=738) or suprarenal (n=13) position through a femoral (n=729) or jugular vein (n=22) approach. Follow-up computed tomographic (CT) scans of the chest and abdomen were evaluated for recurrent PE and filter-related complications, respectively. Results: Three (0.4%) patients developed groin hematoma. During a mean 295-day clinical follow-up (range 1-1677), 55 (7.5%) patients developed symptoms of PE, and 1 (0.1%) death was attributed to PE. Chest CT performed for various clinical indications in 219 patients at a mean 192 days (range 1-1346) showed PE in 15 (6.8%) patients; 10 were symptomatic and 5 asymptomatic, but there were no fatalities. Follow-up abdominal CT (n=270) at a mean 189 days (range 1-1415) showed fracture of filter components in 8 (3.0%), thrombus within the filter in 68 (25.2%), thrombus extending beyond the filter in 4 (1.5%), near total caval occlusion in 2 (0.7%), and no cases of migration, Conclusion: The TrapEase vena cava filter is effective in the prevention of pulmonary embolism, with minimal complications. [ABSTRACT FROM AUTHOR]

Treatment of bulky retroperitoneal malignancy may require en bloc resection of the infrarenal inferior vena cava. A number of reconstructive options are available to the surgeon but objective haemodynamic assessment of the peripheral venous system following resection without replacement is lacking. The aim of the present paper was thus to determine the symptomatic and haemodynamic effects of not reconstructing the resected infrarenal inferior vena cava. A retrospective descriptive study was carried out at Princess Alexandra Hospital in Queensland. Five patients underwent resection of the thrombosed infrarenal inferior vena cava as part of retroperitoneal lymph node dissection for testicular cancer ( n = 3), radical nephrectomy for renal cell carcinoma ( n = 1) and thrombosed inferior vena cava aneurysm ( n = 1). Clinical effects were determined via the modified venous clinical severity score and venous disability score. Haemodynamic data were obtained postoperatively using venous duplex ultrasound and air plethysmography. None of the present patients scored >2 (out of 30) on the modified venous clinical severity score or >1 (out of 3) on the venous disability score. Haemodynamic studies showed only minor abnormalities. Not reconstructing the resected thrombosed infrarenal inferior vena cava results in minor signs and symptoms of peripheral venous hypertension and only minor abnormalities on haemodynamic assessment. [ABSTRACT FROM AUTHOR]

We report an unusual case of solitary thrombus floating in the inferior vena cava (IVC) in a patient who underwent radical nephrectomy for a renal cell carcinoma (RCC) of the right kidney extended into the renal vein with no capsular and perinephric tissue invasion (pT3b). Twenty months after surgery, a routine computed tomography scan identified an intraluminal mass floating in the IVC. Cavotomy and thrombectomy with no caval resection were successfully performed. A review of the literature showed only three previous published cases of RCC recurring in the IVC only, with no local recurrence or distant metastases. We outline the possible etiology of these unusual and solitary recurrences in the IVC and we emphasize the need for a strict surveillance for all patients with RCC and especially for those with pT1b, pT2 and pT3 disease. An early diagnosis of this rare recurrence can permit an easy removal of the thrombus with no caval resection and graft replacement, making this disease potentially curable by surgery. [ABSTRACT FROM AUTHOR]

Intrathoracic infiltration of the inferior vena cava (IVC) is rare; mobilization and prosthetic replacement may increase the risk of cardiac arrest and postoperative complications. We report a case of a giant liposarcoma which elongated and grew around the IVC, invading both hemithoraces. The removal of this mass required a bypass between the left femoral and ipsilateral axillary vein to guarantee an adequate venous return. The IVC was replaced by a polytetrafluoroethylene prosthesis. A postoperative paralysis of patient's lower limbs occurred. Hypotension or involvement of aberrant medullary artery origin could be responsible for this complication. [ABSTRACT FROM AUTHOR]

Endometrial stromal sarcoma (ESS) rarely infiltrates the great vessels. We report a successful surgical resection of the inferior vena cava (IVC) after extensive infiltration with metastatic low-grade ESS. A case of presumed recurrence of low-grade ESS demonstrated complete IVC occlusion from tumour thrombus with extensive local disease. Radical resection of the tumour and caval reconstruction was performed. The IVC graft was thrombosed at short-term follow-up. Curative resection of extensive caval infiltration with metastatic low-grade ESS can be achieved. Caval reconstructive procedures may be redundant in the presence of an adequate collateral circulation. [ABSTRACT FROM AUTHOR]