Segment Of Inferior Vena Cava Research Articles

Impact of Left Renal Vein Ligation on Renal Function Following En Bloc Resection of Segmental Inferior Vena Cava and Right Kidney.

Renal function after left renal vein (LRV) ligation following en bloc resection of segmental inferior vena cava (IVC) and right kidney is understudied. We assessed the impact of LRV ligation on postoperative renal function following en bloc resection of segmental IVC and right kidney. We retrospectively reviewed 28 patients who underwent LRV ligation during en bloc resection of segmental IVC and right kidney. Patient demographics, tumor characteristics, intraoperative factors, complications, length of hospital and intensive care unit (ICU) stay, and patient survival were collected. Pre- and postoperative renal function was retrospectively analyzed. Twenty patients underwent robot-assisted surgery and eight patients underwent open surgery. The median operative time was 162 min and estimated blood loss was 350mL. Ten patients had normal renal function and 12 patients had an initial increase in creatinine but improved gradually. Six patients developed acute renal failure; five patients gradually recovered in 5-32 days after temporary hemodialysis. Renal replacement therapy significantly correlated with maximal anterior-posterior diameter of the LRV (p = 0.001). Complications were observed in 11 cases, four of which were Clavien-Dindo grades I-II. Thirteen patients were alive with no recurrence, nine patients were alive with metastasis, and six cases died during the follow-up period. LRV ligation following en bloc resection of segmental IVC and right kidney is feasible, with no significant long-term impact on renal function. The maximum anterior-posterior diameter of the LRV is a reliable method for predicting renal replacement therapy in the absence of collateral circulation.

Full-Circumference Prosthetic Grafts for Replacing a Retrohepatic Inferior Vena Cava Segment During Hepatectomy for Tumor.

Although hepatectomy including inferior vena cava (IVC) resection is becoming more common, some details remain uncertain such as use of artificial materials to replace a tumor-involved, damaged, or narrowed retrohepatic IVC segment. Surgical outcomes of 12 patients who underwent hepatectomy with IVC resection including reconstruction using synthetic tubular grafts were investigated to clarify safety and feasibility. Operative time (median, 573min; range, 268 to 774) and the blood loss (1076mL; 155 to 2960) were acceptable. In-hospital mortality was 8% (1/12), and morbidity was 42% (5/12). Among the 12 patients, 2 were planned to undergo IVC reconstruction without an artificial graft. In one patient, prosthetic repair was adopted because of massive bleeding from the IVC wall during dissection of tumor from the IVC. In the other, severe stricture became evident during attempted direct closure of the partially resected IVC wall. Ongoing experience has increased our acceptance of combined liver and IVC resection. We believe that segmental IVC resection and reconstruction with a prosthetic tubular graft could be chosen more frequently in managing liver tumors suspected to involve the IVC.

V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION Matthew Lee, Aeen Asghar, David Strauss, Naveen Krishnan, and Daniel Eun Matthew LeeMatthew Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Naveen KrishnanNaveen Krishnan More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although oncologic applications of the surgical robot have become commonplace, its true strength is showcased via complex reconstructive procedures, such as central vessel vascular reconstruction. We demonstrate two cases of inferior vena cava (IVC) robotic assisted laparoscopic (RAL) reconstruction using synthetic grafts. METHODS: First, we show a 78-year-old male with cT3b right renal mass undergoing RAL radical nephrectomy and IVC thrombectomy. After interaortocaval dissection, the right renal artery is divided and the left renal vein, suprarenal IVC, and infrarenal IVC are clamped. The mass invaded a 5-centimeter portion of the IVC, necessitating segmental IVC resection. A 6-centimeter PTFE interposition graft was anastomosed to the IVC to re-establish vascular continuity. Next, a 43-year-old female with an OptEaseTM IVC filter that had eroded through the IVC, deviating the right ureter, required IVC reconstruction. The IVC was clamped proximally and distally. A cavotomy was made and the filter was removed piecemeal. After anterior IVC excision, an 8-centimeter segment of PTFE graft was sutured to the defect as an onlay patch graft. RESULTS: IVC cross clamp time was 108 and 132 minutes, respectively. Length of stay was 6 and 5 days, respectively. Neither patient had any vascular based complications and were discharged home. CONCLUSIONS: We demonstrate that RAL management of complex IVC pathologies requiring IVC reconstruction with synthetic grafts may be safe, feasible, and effective. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Naveen Krishnan More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

Blunt inferior vena cava injury associated with AAST-grade V hepatic and renal injuries: A case report

A 56-year-old female patient presented with right chest and upper abdominal pain in a motorcycle accident. Hypotension and low blood hemoglobin were noted. Contrast-enhanced multi detector computed tomography showed hemoperitoneum, retroperitoneal hematoma, injury of the retro hepatic and suprarenal segments of inferior vena cava, grade V hepatic injury, and grade V right renal injury involving the right main renal vein according to the American Association for the Surgery of Trauma. The surgeon repaired the inferior vena cava, ligated the right renal vein, and packed the liver laceration with pads and gauzes during emergency exploratory laparotomy. The condition remained stable until repeated active bleeding of the liver laceration occurred on the 20th post-operative day, which was successfully managed by trans arterial embolization. The patient was discharged with an eventful course on the 41st hospitalization day.

A 10-year experience of leiomyosarcoma of the inferior vena cava.

Leiomyosarcoma of the inferior vena cava (IVC) is rare. The study reviewed patients with IVC leiomyosarcoma in our hospital in the past ten years. Twenty patients diagnosed with IVC leiomyosarcoma between October 2010 and October 2020 were enrolled. Their clinical manifestations, treatments, and follow-up results were analyzed. The sarcoma was located in the lower IVC segment in six patients, with 13 in the middle and one in the upper IVC segment. Eighteen patients underwent R0 resection. After resection, 16 patients (80%) had primary repair of the IVC, while four patients underwent ligation. During a mean follow-up of 37.7months, seven patients died due to tumor metastasis, four patients were alive with the tumor recurrence and other nine patients were alive without recurrence. The management of the IVC after tumor resection depended on the tumor location and size. R0 resection provided a chance for long term survival.

SURGICAL TECHNIQUE IN LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA DEPENDING ON ITS LOCATION

The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) – circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.

SURGICAL TECHNIQUE IN LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA DEPENDING ON ITS LOCATION.

The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) - circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.

Reconstruction of caval veins

To study the possibilities and results of reconstruction of caval veins. We analyzed the results of reconstruction of caval veins in 31 patients (19 men and 12 women) including superior vena cava (SVC) in 5 cases and inferior vena cava (IVC) in 26 cases. Penetrating wounds with vascular damage were found in 8 patients. Iatrogenic damage to IVC was observed in 19 patients (nephrectomy for kidney cancer - 2, nephrectomy for secondary kidney wrinkling - 1, echinococcectomy from retroperitoneal space - 1, adrenalectomy for adrenal tumors - 5, right-sided lumbar sympathectomy - 1, resection of abdominal aortic aneurysm - 1, resection of a large retroperitoneal tumor - 6). Iatrogenic damage to SVC occurred in 2 patients during resection of mediastinal tumor. In other 4 cases, elective surgery for mediastinal tumor (1), pancreatic head cancer (2) and liver alveococcosis (1) was accompanied by resection and replacement of caval veins. All interventions for caval vein injury were performed under adequate infusion therapy. Seven (22.6%) patients died. One patient with blunt chest trauma and damage to SVC died during thoracotomy. In another patient, infrarenal IVC was intersected during mobilization of retroperitoneal hydatid cyst that required ligation for vital indications. High venous hypertension below the ligature led to eruption of sutures on the venous stump. The patient died from hypovolemia after additional IVC ligation. Other 5 patients died in early postoperative period without leaving the state of shock. These patients had damage to retrohepatic segment of IVC (1), vascular-organ (1) and iatrogenic (3) injuries. One patient died from pulmonary embolism, two patients - from venous bleeding between the 2nd and the 5th postoperative days. Patients died before reoperations. Two patients with postoperative bleeding underwent redo surgery with favorable outcomes. One patient underwent redo surgery for peritonitis with a favorable result. Thus, 7 (22.6%) patients with caval vein injury died in intraoperative and early postoperative period. Non-specific complications occurred in 4 (12.9%) patients. These events were corrected by conservative measures. Other 24 (77.4%) patients with traumatic and iatrogenic injuries of caval veins were discharged. Caval vein injury is less common event compared to other vascular damages. Nevertheless, this complication is accompanied by severe blood loss, shock and hypovolemia. We can only assume damage to a great vessel in patients with penetrating wounds before surgery and appropriate symptoms of internal bleeding. However, final diagnosis is made during surgery. Hemostasis is a responsible and difficult surgical stage in these patients. There is usually no alternative to reconstructive surgery in these cases. However, ligation is permissible in extremely ill patients and only in infrarenal segment of IVC. Vascular suture is a more acceptable and effective option for reconstruction. However, patch repair is advisable for large defects. In our opinion, this approach is better regarding long-term patency compared to total replacement with synthetic prostheses.

A study on morphology of retro hepatic segment of inferior vena cava in Jharkhand population

A study on morphology of retro hepatic segment of inferior vena cava in Jharkhand population

Surgical treatment of the inferior vena cava (IVC) leiomyosarcoma

Objective. To propose and introduce a diagnostic-treatment algorithm for the inferior vena cava (IVC) leiomyosarcoma into clinical practice.
 Materials and methods. During last 30 years in Zakarpattya Regional Clinical Hospital Named After Andriy Novak and Zakarpattya Antitumoral Centre were operated 8 patients, suffering the IVC leiomyosarcoma - 7 (87.5%) women and 1 (12.5%) man. Median of the patients' age have constituted 57 yrs old. For characterization of the affection localization in accordance to own views on the subject the classification of the IVC division into 7 segments was applied: infrarenal, іnterrenal, suprarenal, retrohepatic, іnfradiaphragmatic, supradiaphragmatic,іntracardial. Іntravasal localization of the tumor was observed in 3 (37.5%), extravasal - in 1 (12.5%), mixed - in 4 (50%) patients. In all the patients the open laparotomy approach was applied: in 1 (12.5%) patient median laparotomy was performed, and in 7 (87.5%) - bilateral subcostal laparotomy of a «Chevron» type. For the IVC alloprosthesis in 6 (75%) patients a politetrafluoroethylene prosthesis was applied, while in 2 (25%) - Gore-tex prosthesis of 18-22 mm in diameter. In 5 (62.5%) patients circular resection with the IVC alloprosthesis was done, in 2 (25%) - circular resection, the IVC alloprosthesis and іmplantation of right and left renal veins into the prosthesis, and in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of left renal vein into prosthesis.
 Results. The operation median duration have constituted 215 (160 - 320) min, while the average volume of the blood loss - 305 (250 - 500) ml. The Degree II postoperative complications in accordance to classification of Clavien-Dindo were registered in 2 (25%) patients. Pulmonary thromboembolism, venous thrombosis, thrombosis of prosthesis, as well as intraoperative or immediate postoperative lethality were not observed. In 7 (87.5%) patients a radical intervention was performed. In 3 (37.5%) patients a remote hepatic and pulmonary metastases have been developed, leading to their death in terms from 10 to 34 mo. General one-, two- and a three-ear survival have constituted 87.5, 75 and 62.5%, accordingly.
 Conclusion. Surgical approach of a «Chevron» type and the staged dissection of IVC guarantees an adequate visualization of its іnfra-, іnter- and suprarenal segments. The «piggyback» procedure of hepatic mobilization and Pringle maneuver constitute necessary parts on the stage of dissection in retrohepatic, infradiaphragmatic and supradiaphragmatic segments of IVC. Radical tumoral excision with the IVC prosthesis and implantation, when needed, of renal or hepatic veins - is the only one possibility for improvement of the patients' quality of life in the IVC leiomyosarcoma.

Variations in the Number and Drainage Levels of Retroaortic Left Renal Veins

Abstract Aim: Circumaortic left renal vein (CLRV) and retroaortic left renal vein (RLRV) are the most common variations of the left renal vein and have a retroaortic course. We aimed to detect the anatomical variations of retroaortic left renal veins in terms of their number and entrance levels into the inferior vena cava (IVC). Materials and Methods: The computed tomographic (CT) images of 2804 patients who had undergone abdominal CT examinations in our hospital between May 1, 2017, and June 30, 2017, were evaluated. Results: CLRV variations were detected in 139 (4.96%) patients, while in another 132 (4.71%) RLRV variations were detected. Double branches were present in 15 (10.8%) patients in the RLRV group, and 3 patients (2.3%) in the CLRV group. The most common drainage levels into the IVC for these variations were the L3 vertebra level and the middle 1/3 infrarenal IVC segment. Conclusion: CLRV and RLRV may possess single or double retroaortic branches. The entrance levels into the IVC are various in these variations. Knowing these variations is important for surgical and interventional procedures.

English

BACKGROUND Leiomyosarcomas (LMS) of inferior vena cava (IVC) are rare smooth muscle sarcomas with less than 300 cases described in the literature. Leiomyosarcoma of IVC is, often detected late in the course due to its indolent manifestation. This study intends to discuss the experiences and challenges in diagnosing this rare entity primarily by radiological imaging in a tertiary centre in India. METHODS This is a retrospective analysis of computed tomography (CT) and ultrasound findings in 6 cases of leiomyosarcoma of inferior vena cava who were referred for multidetector computer tomography (MDCT) scan in the Department of Radiodiagnosis of Government Medical College Calicut over the past 7 years by the treating physician. The patients were identified using a prospectively maintained database. RESULTS In this study, there were six patients diagnosed as leiomyosarcoma of IVC, age ranging from 35 and 64 years (mean 47.8 years, SD 10.7) with 4 (66.6 %) females and 2 (33.33 %) males. The mean size of the tumour at the time of diagnosis was 8.4 cm. The segment of IVC most commonly involved was middle segment in 5 patients (83.3 %). In this series, only a single case had tumour entirely confined within the lumen of inferior vena cava without extraluminal extension. Two out of six cases (16.66 %) had lung metastasis at the time of diagnosis. Two cases without metastasis or significant infiltration to adjacent organs were amenable to resection. CONCLUSIONS Leiomyosarcoma of IVC is a rare tumour, often detected late in the course due to its indolent manifestation. High index of suspicion may help in the early diagnosis of so that early treatment can begin and improve the clinical outcome. KEYWORDS Leiomyosarcoma, Inferior Vena Cava, Mesenchymal Neoplasms

The Use of Autologous Falciform Ligament as a Vascular Graft

As a consequence of taking on more complex hepatic resections, vascular reconstruction is frequently required. We report an innovative technique in which autologous falciform ligament was used to reconstruct the inferior vena cava (IVC). A 57-year-old male presented with recurrence of a retro-peritoneal low-grade spindle cell carcinoma 7 years following radical resection of a right supra-renal retroperitoneal tumour in 2012. The recurrence was situated posterior to the liver, involving the dorsal aspect of the right liver and retro-hepatic IVC, up to but not including the confluence of the hepatic veins (HV). The liver was transected on the middle HV, leaving the tumour attached to the right liver and IVC. The segment of involved IVC was isolated with complete caval occlusion. Single catheter veno-venous bypass via the left femoral vein to the left internal jugular was established. The segment of IVC that was resected en bloc with the right liver was reconstructed using autologous falciform ligament. At six months post-operatively the patient has a patent IVC with no evidence of tumour recurrence. Falciform ligament is an autologous graft that is readily accessible, and as it is a double membrane structure, is sufficiently strong to be used for venous reconstruction.

A new classification for hepatocellular carcinoma with hepatic vein tumor thrombus.

Hepatic vein tumor thrombus (HVTT) is a significant poor risk factor for survival outcomes in hepatocellular carcinoma (HCC) patients. Currently, the widely used international staging systems for HCC are not refined enough to evaluate prognosis for these patients. A new classification for macroscopic HVTT was established, aiming to better predict prognosis. This study included 437 consecutive HCC patients with HVTT who underwent different treatments. Overall survival (OS) and time-dependent receiver operating characteristic (ROC) curve area analysis were used to determine the prognostic capacities of the new classification when compared with the different currently used staging systems. The new HVTT classification was defined as: type I, tumor thrombosis involving hepatic vein (HV), including microvascular invasion; type II, tumor thrombosis involving the retrohepatic segment of inferior vena cava; and type III, tumor thrombosis involving the supradiaphragmatic segment of inferior vena cava. The numbers (percentages) of patients with types I, II, and III HVTT in the new classification were 146 (33.4%), 143 (32.7%), and 148 (33.9%), respectively. The 1-, 2-, and 3-year OS rates for types I to III HVTT were 79.5%, 58.6%, and 29.1%; 54.8%, 23.3%, and 13.8%; and 24.0%, 10.0%, and 2.1%, respectively. The time-dependent-ROC curve area analysis demonstrated that the predicting capacity of the new HVTT classification was significantly better than any other staging systems. A new HVTT classification was established to predict prognosis of HCC patients with HVTT who underwent different treatments. This classification was superior to, and it may serve as a supplement to, the commonly used staging systems.

A Predictive Model for Tumor Invasion of the Inferior Vena Cava Wall Using Multimodal Imaging in Patients with Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus.

Purpose Developed a preoperative prediction model based on multimodality imaging to evaluate the probability of inferior vena cava (IVC) vascular wall invasion due to tumor infiltration. Materials and Methods We retrospectively analyzed the clinical data of 110 patients with renal cell carcinoma (RCC) with level I-IV tumor thrombus who underwent radical nephrectomy and IVC thrombectomy between January 2014 and April 2019. The patients were categorized into two groups: 86 patients were used to establish the imaging model, and the data validation was conducted in 24 patients. We measured the imaging parameters and used logistic regression to evaluate the uni- and multivariable associations of the clinical and radiographic features of IVC resection and established an image prediction model to assess the probability of IVC vascular wall invasion. Results In all of the patients, 46.5% (40/86) had IVC vascular wall invasion. The residual IVC blood flow (OR 0.170 [0.047-0.611]; P = 0.007), maximum coronal IVC diameter in mm (OR 1.203 [1.065-1.360]; P = 0.003), and presence of bland thrombus (OR 3.216 [0.870-11.887]; P = 0.080) were independent risk factors of IVC vascular wall invasion. We predicted vascular wall invasion if the probability was >42% as calculated by: {Ln [Pre/(1 − pre)] = 0.185 × maximum cornal IVC diameter + 1.168 × bland thrombus–1.770 × residual IVC blood flow–5.857}. To predict IVC vascular wall invasion, a rate of 76/86 (88.4%) was consistent with the actual treatment, and in the validation patients, 21/26 (80.8%) was consistent with the actual treatment. Conclusions Our model of multimodal imaging associated with IVC vascular wall invasion may be used for preoperative evaluation and prediction of the probability of partial or segmental IVC resection.

How to do liver transplantation using liver allografts with damaged supra-hepatic inferior vena cava.

During deceased donor procurement, the heart procurement team may cut the supra-hepatic inferior vena cava (IVC) too close to the liver surface, depriving the liver allograft from having enough supra-hepatic IVC to perform the anastomosis with the recipient's IVC or hepatic veins. In such instances, liver grafts usually are deemed as non-appropriate for transplantation, being discarded. Here we report a technique for reconstruction of damaged supra-hepatic IVCs through the use of a segment of the infra-hepatic IVC of the liver graft.

Embryological and surgical considerations of absent infra-renal part of inferior venacava and left renal vein

Background: Development of inferior vena cava (IVC) is a complex process that involves the anastomoses between three pairs of embryonic veins. Specific permutations exist in the venous plane of the abdomen and pelvis resulting in variations such as single left IVC, double IVC, and left renal retroaortic vein. Anomalies of the inferior vena cava and renal veins occur infrequently but may contribute to serious morbidity throughout surgical exploration if unidentified. Most anomalies remain asymptomatic until surgical intervention or clinical presentation with thromboembolic complications.
 Aims and Objective: Our research is aimed to link embryology with developmental disorder and the complications associated with the anomalous vessels in the field of surgery.
 Materials and Methods: Ten IUD fetuses (ranging from 20 weeks to term fetuses) were collected from the O&G department of the college and injected locally with dilute formalin and placed in containers filled with formalin. Dissection of the fetuses was done to identify congenital anomalies.
 Results: The external appearance of the 28-week-old fetus showed no gross anomaly. Examination abdominal cavity showed absent infrarenal segment of IVC and left renal vein. The right renal vein was seen running a long course to the left side with tributaries of lumbar veins and was seen continuing as the left femoral vein medial to the femoral artery. Segments of suprarenal and renal IVC were present.
 Conclusion: Correlating anomalies and variations of IVC and its tributaries to embryology. However, understanding of such anomaly is necessary to avoid significant diagnostic pitfalls and in preoperative surgicaland radiological intervention planning.

Sequential interventional therapy for Budd-Chiari syndrome associated with fresh inferior vena cava thrombosis

ObjectiveOur study aimed to evaluate the safety and efficacy of sequential interventional therapy for Budd-Chiari syndrome (BCS) caused by obstruction of the inferior vena cava (IVC) with fresh thrombus in the IVC. MethodsFull medical records were obtained for 20 patients with BCS associated with fresh IVC thrombus who received sequential interventional therapy from 2014 to 2019 at our hospital. All patients underwent small-diameter percutaneous transluminal angioplasty (PTA) balloon catheter predilation combined with sequential catheter-directed thrombolysis and large-diameter PTA balloon dilation. Ultrasound examinations were performed at 1 week, 1 month, 3 months, and every 6 months thereafter. Therapeutic effects and perioperative and postoperative adverse effects were recorded to assess the safety of the treatment. ResultsAll 20 patients were treated with small PTA balloon catheters (diameter, 10-14 mm) to predilate the occlusive segment of the IVC. Urokinase 400,000 to 600,000 (465,000 ± 93,000) units was administered to patients through the catheter for 6 to 20 (9.7 ± 4.2) consecutive days postoperatively. Ultrasound re-examination showed that the IVC thrombus disappeared completely in 14 patients (70.0%), and a small amount of the old thrombus remained in 6 patients (30.0%). After thrombolysis, all 20 patients received PTA balloon dilation (diameter, 26-30 mm) in the stenosed IVC segment, and blood flow recovered subsequently. No pulmonary embolism or death occurred in the perioperative course. The perioperative survival rate was 100.0%. ConclusionsSequential interventional therapy for BCS associated with fresh IVC thrombus is safe and effective.

Initial Series of Robotic Segmental Inferior Vena Cava Resection in Left Renal Cell Carcinoma With Caval Tumor Thrombus

OBJECTIVETo present our preliminary experience of robotic left radical nephrectomy (LRN) and segmental inferior vena cava (IVC) resection without caval replacement for left renal cell carcinoma (RCC) with inferior vena cava tumor thrombus. MATERIALS AND METHODSBetween 2017 and 2018, 7 patients underwent segmental IVC resection and LRN robotically. All patients underwent preoperative cavography, demonstrating complete IVC occlusion. Computed tomography-based 3-dimensional reconstruction revealed sufficient collateralization of the IVC and right renal vein (RRV). The cephalic IVC was circumferentially resected and ligated just below the second porta hepatis. The caudal IVC was circumferentially resected above the RRV with preservation of the major collaterals. The RRV was not dissected during the procedure to avoid compromising its neocollaterals. The IVC portion between the RRV and the second porta hepatis was removed en bloc with the tumor thrombus, and the LRN was performed. RESULTSAll cases were successfully performed by robotic surgery without conversion. Median operative time was 420 minutes. Median intensive care unit stay was 3 days. Four grade Ⅱ complications occurred in 2 patients. One patient had mild LEE postoperatively and recovered without special medication. Median preoperative and 3-6 months follow-up serum creatinine was 118.7 μmol/L and 135.2 μmol/L, respectively. No patient needed dialysis postoperatively. One case occurred disease progression. No patient died during the follow-up period. CONCLUSIONRobotic segmental IVC resection for left RCC with inferior vena cava tumor thrombus is feasible in well-selected cases. Three-dimensional reconstruction and cavography are helpful in the preoperative evaluation of neocollaterals in patients with suprarenal IVC occlusion.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.