title: Early occlusion control of the intrapericardial inferior vena cava under femoral-femoral extracorporeal circulation using a technique to prevent pulmonary embolism during nephrectomy for renal cell carcinoma with tumor thrombus: two case reports.
abstract: BACKGROUND
  Renal cell carcinoma with tumor thrombus extension into the inferior vena cava occurs in approximately 5% of cases. Despite such situations, an aggressive surgical approach is recommended. However, intraoperative prevention of pulmonary embolism by a fragmended tumor thrombus is necessary. To prevent pulmonary embolism, placement of a temporary suprarenal filter has been attempted, however, the precise placement of a temporary filter between the level of the hepatic vein and right atrium is not always easy because of its migration, tilting, and strut fracture. Here we report a method for early occlusion control of the intrapericardial inferior vena cava to prevent pulmonary embolism during nephrectomy in level II or III renal cell carcinoma tumor thrombus.
  
  
  METHODS
  Our first case was a 37-year-old Japanese man with left renal cell carcinoma extending into the inferior vena cava below the main hepatic vein (level II) and our second was a 75-year-old Japanese man with right renal cell carcinoma extending into the retrohepatic inferior vena cava at the main hepatic vein (level III). En block resection of the kidney and the tumor thrombus was performed with the aid of partial extracorporeal circulation; the postoperative course of both patients was uneventful.
  
  
  CONCLUSIONS
  Control of intrapericardial inferior vena cava is a feasible method to prevent pulmonary embolism.
authors.affiliation: Department of Urology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. miyaz929@med.u-ryukyu.ac.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Miyazato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashiro
authors.forename: Masato
authors.initials: M
authors.lastname: Goya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Inafuku
authors.forename: Akashi
authors.initials: A
authors.lastname: Ikehara
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Oshiro
authors.forename: Seiichi
authors.initials: S
authors.lastname: Saito
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kuniyoshi
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery*; D005112:Extracorporeal Circulation / Q000379:methods*; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000517:prevention & control*; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior