NEW ORLEANS, LA USA (UroToday.com) - Management of IVC tumor thrombus is challenging, and residual tumor may be present within the caval lumen if the tumor is friable or extends significantly caudally or cranially. Residual thrombus can be seen on postoperative CT scans in up to 36% of patients and is a risk factor for VTE events. Jeffrey Loh-Doyle described the University of Southern California experience in use of vena cavoscopy after thrombectomy to look for occult residual bland or tumor thrombus.
In order to perform cavoscopy, complete control of the vasculature is achieved with tourniquets and a 16 Fr flexible cystoscope with high flow heparinized saline is passed in order to visualize the lumen. In their series of 36 patients, 19 patients had supradiaphragmatic, 11 had intrahepatic, and 6 infrahepatic thrombi. Renal vein wall invasion was present in 12 patients and IVC wall invasion was present in 7. Five patients required cardiopulmonary bypass, and 8 required cavectomy. There were no complications attributed to cavoscopy. Eight of 36 patients had residual thrombus and required adjunct surgical procedures for thrombectomy. Tumor was free floating and easily extracted in 2 patients, adherent to the wall in 5 patients, and in the hepatic veins in 1 patient who died of cardiopulmonary complications.
There was discussion about use of intraoperative TEE but the point was made that TEE will not identify residual thrombus in the caudal cava. Cavoscopy in a trans-atrial approach was also mentioned by Michael Blute, but that was not performed in the current study.
Presented by Jeffrey Loh-Doyle at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of Southern California, Los Angeles, CA USA
Reported by Phillip Abbosh, MD, PhD, medical writer for UroToday.com