Inferior venacavography in the preoperative assessment of renal adenocarcinoma

Although inferior venacavography has been suggested as a routine test for patients with renal adenocarcinoma we have used urographic criteria of a large and/or medially placed tumor, and/or decreased visualization of the affected kidney to select patients for inferior venacavography. Of 235 patients with renal adenocarcinoma undergoing excretory urograms 64 of 76 (84 per cent) with gross renal vein involvement and 72 of 151 (47 per cent) without renal vein involvement had at least 1 criterion. All 20 patients with inferior vena caval thrombi and excretory urograms had at least 1 criterion. High dose selective renal angiography identified successfully a renal vein thrombus in 11 patients, 4 with inferior vena caval thrombi, while the renal vein was not visualized in 7 with renal vein involvement and 1 with an inferior vena caval thrombus. Inferior venacavography identified correctly an inferior vena caval thrombus in 16 patients. With the correct preoperative identification in 19 of 22 patients with inferior vena caval thrombi our criteria for inferior venacavography are outlined.