Endovascular Biopsy of an Inferior Vena Cava Mass: A Case Report

Abstract

We describe the case of an 82-year-old female referred to the vascular clinic for further evaluation and management of suspected inferior vena cava (IVC) thrombosis. She had previously presented to the general practitioner with a one-week history of vague abdominal pain in the right and left loins. Contrast-enhanced magnetic resonance imaging (MRI) of the abdomen and magnetic resonance angiography/magnetic resonance venography (MRA/MRV) revealed a 10 cm filling defect in the IVC, with the inferior margin of ≈5.8 cm proximal to the aortic bifurcation and its superior margin in the intrahepatic portion of the IVC. The filling defect had a transverse diameter of 2.6 cm and displayed heterogenous enhancement with contrast.We performed an endovascular biopsy with fluoroscopy (anteroposterior {AP} and lateral views) being utilized throughout the procedure to locate the mass and position the forceps in the tumor bed. The IVC was accessed via the right common femoral vein with a 10F catheter sheath. The sheath was advanced using the Seldinger technique to within ≈1 cm of the mass; then, a biopsy forceps (Micro-Tech single-use 8.5 mm biopsy forceps, Nanjing, China) was inserted, and six tissue samples were obtained.We report this case to add to the growing evidence that endovascular biopsy of IVC tumors can be performed safely and effectively.

Transvenous biopsy of inferior vena cava leiomyosarcoma: two case reports

“…Leiomyosarcomas of the inferior vena cava (IVC) are extremely rare malignancies, with only a few hundred cases reported in the literature [1] , [2] , [3] , [4] , [5] . They carry a poor prognosis.…”

“…Typically, biopsy is performed percutaneously. However due to their rarity, much remains unknown about optimal diagnostic management of the disease outside of evidence from a few case reports in the literature [1] , [2] , [3] , [4] , [5] .…”

Editorial Comment to Small renal cell carcinoma accompanied by extensive inferior vena cava tumor thrombus diagnosed by percutaneous transvenous biopsy

“… 4 Another possible option is endovascular biopsy, which has been reported as an emerging technique alternative to the percutaneous approach. 5 This technique can be done with local anesthesia, and is associated with lower risk of massive hemorrhage, according to a previous report. 5 Growing evidence will allow for the evaluation of its feasibility soon.…”

“… 5 This technique can be done with local anesthesia, and is associated with lower risk of massive hemorrhage, according to a previous report. 5 Growing evidence will allow for the evaluation of its feasibility soon.…”