Cavoatrial thrombectomy in hepatocellular carcinoma with tumor thrombus in the vena cava and atrium without the use of cardiopulmonary bypass.

Abstract:

BACKGROUND:Hepatocellular carcinoma (HCC) with tumor thrombus (TT) in hepatic vein, inferior vena cava (IVC), and right atrium (RA) portends a poor prognosis because of intravascular extension leading to rapid distal metastases. En bloc resection of cavoatrial TT without the use of cardiopulmonary bypass (CPB) is challenging. We describe a new method of vascular occlusion for thrombus entering into the RA without the need for CPB as shown in echocardiography. METHODS AND RESULTS:Retrospective analysis was carried out in 1 HCC patient, who had undergone hepatectomy with TT extension into IVC and RA. The infrahepatic IVC was occluded with vascular tape and the right atrial appendage was controlled with a Satinsky clamp proximal to the TT. The IVC wall was incised under direct vision from the infrahepatic IVC cranially. The tumor and thrombus were then removed en bloc under direct vision. Thus, cavoatrial thrombectomy was performed under total hepatic vascular exclusion without the use of CPB. He survived for 6 months and died of tumor recurrence. CONCLUSIONS:Using this technique, advanced HCC with cavoatrial TT can be resected safely without CPB and thereby avoid dislodgement of TT and air embolism.

journal_name

Ann Vasc Surg

authors

Li AJ,Yuan H,Yin L,Che Q,Lang XL,Wu MC

doi

10.1016/j.avsg.2014.02.021

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

1565.e5-8

issue

6

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(14)00116-2

journal_volume

28

pub_type

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