“Heparin less” Venovenous Bypass for Renal Cell Carcinoma Involving the Inferior Vena Cava: A Case Report

Abstract

This presentation offers a simple yet effective method of venovenous bypass without systemic heparinization to assist in the surgical intervention of renal cell carcinoma involving the inferior vena cava. This system is comprised of a closed BioMedicus (a) centrifugal pump system and cannulation sites of femoral vein and axillary vein. No direct cardiac cannulation is made. Renal cell carcinomas involving the inferior vena cava have been surgically treated by means of cavotomy, often with major loss of blood (1). Risks also include embolization to the right heart and lungs, poor visualization with less than desirable results, uncertainty as to retrieval of tumor thrombus, and the possibility of decreased return of venous blood to the right heart and those sequelae. Other surgical measures have included cardiopulmonary bypass with or without circulatory arrest. Also, a venovenous bypass from femoral vein to right atrium has been conducted (2, 3). Some complications associated with these uses will be discussed in the following text The degree of inferior vena caval involvement in this case report extended to the diaphragm and was handled surgically with the assist of this venovenous bypass system, but cases involving thrombus above the level of the diaphragm might also be considered depending on the extent and surgeon discretion. The bypass described herein affords a simple, convenient method to offer hemodynamic stability in the surgical procedure without cannulation of the heart and systemic heparinization. This bypass will be utilized in future cases based on individual situations.