Polytetrafluoroethylene expanded prosthesis as replacement of the inferior vena cava in renal cell carcinoma with caval thrombus

Bourazza, Ahmed; Khodari, M.; Yakoubi, Rachid; Lambert, Marc; Koussa, Mohamad; Ghoneim, T.; Haulon, Stéphan; Villers, Arnauld; Lemaître, L.; Zini, Luca

doi:10.1111/iju.12339

Cited by 10 publications

(14 citation statements)

References 24 publications

(36 reference statements)

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“…7, 21, 22 One recent study, published by Benkirane et al , explored IVC resection and reconstruction with PTFE in 26 cancer patients. 6 They had a median follow-up of 28 months, during which time 19.2% of grafts thrombosed ( n =5). Patency of the replaced IVC at 6 and 12 months was 88% and 79%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Complete IVC replacement, prosthetic and autogenous patching, as well as primary lateral venorrhaphy are all described in the literature. 6-8 Available conduits and patches are made of polytetrafluoroethylene (PTFE), autologous vein, and bovine pericardium. Vein harvest for creation of a large caliber spiral graft is time consuming, limiting its utility, especially during repair of an iatrogenic injury.…”

Section: Introductionmentioning

confidence: 99%

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The enduring patency of primary inferior vena cava repair

Mansukhani

Havelka

Helenowski

et al. 2017

Surgery

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Objective Inferior vena cava (IVC) repair after planned and unplanned venotomy is performed by either interposition bypass, patch venopasty, or lateral venorrhaphy and primary repair. Primary repair of the IVC avoids the use of foreign material and allows an all-autologous repair in an expeditious fashion. The purpose of this study was to demonstrate the utility of IVC repair, determine the degree of IVC stenosis and examine clinical outcomes after primary repair. Methods Single-center retrospective review of patients who underwent primary IVC repairs between January 2002 and January 2014 at a tertiary care center. Primary repair followed lateral venorrhaphy for tumor extraction or for repair of an iatrogenic IVC injury. Patient demographics, cross-sectional vena cava dimensions, and patient outcomes were tabulated. Results In total, 47 (30 men and 17 women) patients underwent primary IVC repair (median age 58 years, range 31-83 years). Twenty-six patients (15 men and 11 women) underwent en bloc radical nephrectomy, IVC tumor thrombus extraction, and primary lateral venorrhaphy (median age 61 years, range 39-83 years). The majority, 92% of these patients, had renal cell carcinoma (RCC) on final pathology, with a median follow-up period of 39 months (range 1-108 months). Twenty-one patients (15 men and 6 women) underwent primary repair for iatrogenic IVC injury (median age 54 years, range 31-82 years). Median follow-up period was 18.5 months (3-110 months). Clinic follow up with postoperative imaging was obtained in 76.9% of those undergoing tumor thrombus extraction (n=20) and 76.2% of those undergoing repair of an iatrogenic injury (n=16). Overall there was a 13% infra-renal IVC diameter loss, 17% IVC diameter loss at the level of the renal veins, and 10% supra-renal IVC diameter loss when comparing postoperative with preoperative imaging. All patients remained asymptomatic; therefore, IVC narrowing associated with primary repair was clinically insignificant. Conclusion Primary IVC repair is associated with less than 20% IVC diameter loss, and does not compromise venous outflow from the extremities. Primary IVC repair is a safe and expeditious technique that provides excellent clinical outcomes and long-term patency.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The enduring patency of primary inferior vena cava repair

Mansukhani

Havelka

Helenowski

et al. 2017

Surgery

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“…In accordance with recent publications the use of polytetrafluoroethylene expanded prosthesis (PTFE) is preferred to a Dacron graft [5,29,30]. The reconstructive regimen depends on the affected caval segment, the availability of retroperitoneal collateral circulation and the invasion of adjacent structures.…”

Section: Surgical Strategiesmentioning

confidence: 90%

“…One of the unique features of RCC is the tumor thrombus formation that migrates into the venous system including renal vein (RV) and inferior vena cava (IVC) with an incidence varying from 4 to 10 % among RCC cases [4][5][6][7][8]. RCC detection age ranges from 55 to 71 years [1].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the prognostic factors and the efficacy of extended resection remain controversial. Aggressive surgical management including nephrectomy with thrombectomy is currently the standard therapeutic approach for RCC patients with tumor thrombus extending to the RV or the IVC [5,9]. Pre-surgical down-staging with the use of molecular targeted therapy has also been proposed in patients with poor prognostic factors, extended tumor thrombus and distant metastases [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Benefit of Surgical Management of Renal Cell Carcinoma Invading the Inferior Vena Cava

Mastoraki

Tsikala‐Vafea

et al. 2016

Indian J Surg Oncol

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Renal cell carcinoma (RCC) accounts for approximately 3 % of adult malignancies and 90-95 % of neoplasms arising from the kidney. One of the unique features of RCC is the tumor thrombus formation that migrates into the venous system including renal vein (RV) and inferior vena cava (IVC). Only 10 % of patients with RCC present with the classic triad of flank pain, hematuria and defined mass, while 25-30 % of affected patients are asymptomatic. Signs of paraneoplastic syndrome such as hypercalcemia, hypertension, anemia, cachexia and increased erythrocyte sedimentation rate (ESR) are often apparent. Extension of tumor thrombus into the venous system is depicted by radiological examinations, such as contrast enhanced Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and vena cavography. The level of the thrombus is mostly determined according to the Mayo classification. Despite recent research on the therapeutic strategies against advanced RCC, surgical resection appears the only potentially curative approach. Aggressive surgical management including nephrectomy with thrombectomy is currently the standard therapeutic approach for RCC patients with tumor thrombus extending to the RV or the IVC. Pre-surgical down-staging with the use of molecular targeted therapy has also been proposed. Alternative therapies, such as radio-and chemotherapy proved insufficient. The aim of this review is to evaluate the results of surgical treatment for RCC invading IVC with special reference to the extent of its histological spread. Review of recent world literature was accomplished to provide an update on the current concepts of surgical management of the disease.

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