Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma.
BACKGROUND
We investigated the advantages of intraoperative transesophageal echocardiography (TEE) during inferior vena caval tumor thrombectomy in renal cell carcinoma (RCC).


METHODS
Five patients with RCC that extended into the inferior vena cava (IVC) underwent radical nephrectomy. To remove the tumor thrombus in the IVC, an inflated Fogarty balloon catheter was used to pull the thrombus below the level of the hepatic veins with real-time TEE monitoring.


RESULTS
In all cases, TEE monitoring during surgery provided an accurate and excellent view of the IVC thrombus. TEE was particularly helpful for the thrombectomy to minimize hepatic mobilization by using occlusion balloon catheter in two patients whose thrombus extended to the intrahepatic IVC.


CONCLUSIONS
Intraoperative real-time TEE monitoring is a safe, minimally invasive technique that can provide accurate information regarding the presence and extent of IVC involvement, guidance for placement of a vena caval clamp, confirmation of complete removal of the IVC thrombus and intervention using catheters to assist in thrombectomy.
Oikawa
Takehiro
T
Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-City, Ibaraki, Japan.
Shimazui
Toru
T
Johraku
Akira
A
Kihara
Shinichi
S
Tsukamoto
Sadamu
S
Miyanaga
Naoto
N
Hattori
Kazunori
K
Kawai
Koji
K
Uchida
Katsunori
K
Takeshima
Hitoshi
H
Saito
Shigeyuki
S
Toyooka
Hidenori
H
Akaza
Hideyuki
H
D000328:Adult; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002404:Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009392:Nephrectomy; D017131:Thrombectomy / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*