Palliative iliac vein-to-right atrium bypass in a patient with a prior vena cava ligation for invasive renal cell carcinoma

Joshua C Grimm; Robert J Beaulieu; Clinton D Kemp; Phillip M Pierorazio; Ashish S Shah; James H Black 3rd

doi:10.1016/j.jvsc.2014.08.001

Palliative iliac vein-to-right atrium bypass in a patient with a prior vena cava ligation for invasive renal cell carcinoma

J Vasc Surg Cases. 2015 Mar 14;1(1):6-8. doi: 10.1016/j.jvsc.2014.08.001. eCollection 2015 Mar.

Authors

Joshua C Grimm¹, Robert J Beaulieu², Clinton D Kemp¹, Phillip M Pierorazio³, Ashish S Shah¹, James H Black 3rd²

Affiliations

¹ Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Md.
² Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Baltimore, Md.
³ Brady Urological Institute and Department of Urology, The Johns Hopkins Hospital, Baltimore, Md.

Abstract

Renal cell carcinoma can involve the inferior vena cava and extend into the right atrium. Cure is rarely achieved in patients with concomitant metastases, but cytoreductive nephrectomy and eradication of the entire tumor thrombus can extend survival and prevent symptoms of venous congestion; however, the invasive nature of the tumor thrombus can make resection with negative margins difficult. We present a patient with aggressive renal cell carcinoma that demanded an iliac vein-to-right atrium bypass after inferior vena cava ligation during a previous attempt at curative resection with nephrectomy and caval thrombectomy.