Optional caval filter in kidney cancer patients with tumor thrombus level I and II

Kidney diseases requiring a radical surgical approach can come up complicated by the presence of a thrombus of the renal vein or the inferior vena cava (IVC). The overwhelming majority of these cases concern the presence of a kidney tumor, especially renal cell carcinoma (RCC). Kidney tumor presenting with thrombus extension into the IVC represents a difficult operative challenge, especially for the risk of thrombus dislocation due to the manipulation of the IVC during tumor isolation, which may result in pulmonary embolism (PE).

We propose a retrospective cohort study regarding 10 patients (thrombus level I or II) operated in our center from 2010 to 2015. All of them had a renal tumor. In 8 patients TC proved tumor thrombus extended into the IVC<2 cm above the renal vein (level I), in the remaining patients the thrombus entered the IVC>2 cm above the renal vein but below the hepatic veins (level 2). All the patients underwent an IVC temporary/optional filter placement as a preoperative maneuver before radical nephrectomy.

The efficacy of the procedure is confirmed by the absence of any inter- or postsurgical thromboembolic event in all patients; filter was removed in 3 patients, moreover, concerning the long-term information we obtained about the patients, none of them has showed complete occlusion of IVC.

The results of the study support effectiveness of preoperative temporary IVC placement to prevent thrombosis embolism shedding and to improve surgical safety.