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

BACKGROUND: 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).

METHODS: 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.

RESULTS: 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.

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