V5-03: Novel Technique for Pre-Operative Removal of Intracardiac Thrombus Prior to Radical Nephrectomy and IVC Thrombectomy
Patients with intracardiac extension of inferior vena caval thrombus from renal cell carcinoma represent a difficult population for surgical planning. Here we present a case in which the thrombus is removed percutaneously via transvenous mechanical thrombectomy to the level of the renal vein ostium.
A patient with stage T3c renal cell carcinoma with thrombus extension into the right ventricle developed pre-operative pulmonary emboli to the right lung, precluding safe use of cardiopulmonary bypass for surgical removal. In order to down-stage the tumor by removing the thrombus, the patient underwent transvenous mechanical thrombectomy. The patient was placed on extracorporeal membrane oxygenation, and access gained via right internal jugular vein. The thrombus was then removed from the lead point within the right ventricle.
Post-procedure cavogram demonstrated removal of the thrombus to the level of the renal vein ostium, effectively downstaging the tumor to T3b. The patient was then able to safely undergo radical nephrectomy with IVC thrombectomy without the use of cardiopulmonary bypass.
To our knowledge, this is the first described method of removing intracardiac thrombus via percutaneous transvenous mechanical thrombectomy. The technique has promise to change the approach to stage 3 renal cell carcinoma and decrease surgical morbidity.