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Vol. 90, No. 4, 2013
Issue release date: May 2013

Release of the Inferior Vena Cava Ligament during Caval Thrombectomy Causing Tumor Thrombus Embolization

Joshi S. · Gorin M.A. · Ciancio G.
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Abstract

Intraoperative tumor embolization is a rare complication during the surgical management of renal cell carcinoma with tumor thrombus of the inferior vena cava (IVC). We present a case of pulmonary tumor embolism which occurred during liver mobilization immediately following division of the IVC ligament. We hypothesize that this patient's IVC ligament acted as an external barrier to propagation of the tumor thrombus and that its release caused the tumor to rapidly expand leading to embolization. To our knowledge, this is the first report of a pulmonary tumor embolism occurring immediately following division of the IVC ligament.



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References

  1. Shuch B, Larochelle JC, Onyia T, et al: Intraoperative thrombus embolization during nephrectomy and tumor thrombectomy: critical analysis of the University of California-Los Angeles experience. J Urol 2009;181:492-499.
  2. Ciancio G, Livingstone AS, Soloway M: Surgical management of renal cell carcinoma with tumor thrombus in the renal and inferior vena cava: the University of Miami experience in using liver transplantation techniques. Eur Urol 2007;51:988-995.
  3. Parekh DJ, Cookson MS, Chapman W, et al: Renal cell carcinoma with renal vein and inferior vena caval involvement: clinicopathological features, surgical techniques and outcomes. J Urol 2005;173:1897-1902.
  4. Ciancio G, Vaidya A, Savoie M, Soloway M: Management of renal cell carcinoma with level III thrombus in the inferior vena cava. J Urol 2002;168:1374-1377.

    External Resources

  5. Makuuchi M, Yamamoto J, Takayama T, et al: Extrahepatic division of the right hepatic vein in hepatectomy. Hepatogastroenterology 1991;38:176-179.

    External Resources

  6. Kogure K, Ishizaki M, Nemoto M, et al: Close relation between the inferior vena cava ligament and the caudate lobe in the human liver. J Hepatobiliary Pancreat Surg 2007;14:297-301.
  7. Hirai I, Kimura W, Murakami G, Suto K, Fuse A: Surgical anatomy of the inferior vena cava ligament. Hepatogastroenterology 2003;50:983-987.

    External Resources

  8. Rigberg DA, Jimenez JC, Lawrence PF: Balloon control of the suprahepatic inferior vena cava: a novel technique for renal cell carcinoma tumor thrombus. Ann Vasc Surg 2008;22:200-202.


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