NEPHRECTOMY WITH IVC THROMBECTOMY (LEVEL-III) CONDUCTED ON VENO-VENO BYPASS
TARIQ S. HAKKY, LUCAS R. WIEGAND, DEVANNAND MANGAR, ANGEL ALSINA, PHILIPPE E. SPIESS
Department of Urology; The University of South Florida and H. Lee Moffitt Cancer Center, Tampa, Florida, USA
We report a 43 year old man who was diagnosed with a level-I thrombus
and was managed on oral sunitinib for two months by a community Urologist.
The thrombus progressed to a level-III and he subsequently developed a
pulmonary embolus, which required oral anticoagulation. He was then referred
to our facility for definitive surgical care. A computed tomography scan
demonstrated a 12 by 15 centimeter right renal mass and on magnetic resonance
venography of the abdomen a tumor-thrombus extending into the infradiaphragmatic
inferior vena cava was noted. Pre-operatively consults with hepatobiliary,
vascular, and chest surgeons were obtained.
The group of Spiess and colleagues has produced an eloquent and timely video. With a trend towards highlighting minimally invasive surgery, we should also try to maintain our skills with respect to the management of conditions requiring major surgery. The use of venous bypass, which was nicely demonstrated in this video, illustrates the advantage in terms of exposure and blood loss afforded by this technique. Furthermore, due to the controlled nature of the ensuing dissection, there is a decreased risk of devastating complications such as emboli and damage to the contralateral kidney. The presence of an appropriate infrastructure with availability of a multidisciplinary team cannot be overemphasized. When done safely, as demonstrated in this video, the results have huge benefits as many patients with renal thrombi enjoy long-term survival.