title: Balloon control of the suprahepatic inferior vena cava: a novel technique for renal cell carcinoma tumor thrombus.
abstract: Renal cell carcinoma has a tendency to extend via the renal vein into the inferior vena cava (IVC), and we describe a novel approach to this situation. A 64-year-old male presented with metastatic right renal cell carcinoma and tumor thrombus extending into the retrohepatic IVC. Preoperative imaging revealed a large hemangioma adjacent to the IVC, potentially complicating hepatic mobilization. Instead, we used a compliant balloon to occlude the suprahepatic IVC, securing the wire in the right hepatic vein. With the infrarenal IVC and left renal vein occluded, the thrombus was extracted via a right renal venotomy/partial cavotomy with minimal bleeding. Balloon occlusion of the suprahepatic IVC offers a safe alternative to surgical control of this vessel in difficult situations. In addition, it allows for nephrectomy through a conventional, small retroperitoneal incision rather than the extended exposure needed for the IVC. Hepatic vein positioning of the wire prevents thrombus manipulation during balloon placement.
authors.affiliation: Department of Vascular Surgery, University of California-Los Angeles, Los Angeles, CA 90095-6908, USA. drigberg@mednet.ucla.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Rigberg
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Jimenez
authors.forename: Peter F
authors.initials: PF
authors.lastname: Lawrence
mesh_terms: D021721:Balloon Occlusion; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000556:secondary; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating; D014682:Vena Cava, Inferior