Tumor and Thrombotic Obstruction of the Inferior Vena Cava - Causes, Variants of Formation, Diagnosis, Surgical Treatment

Evgenii Gavrilov, Gennadiy Khubulava, Viktor Tarasov, Iliya Larin

MILITARY-MEDICAL ACADEMY, Saint -Petersburg, Russia

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective: Objective this study was making recommendations for the selection of surgical tactics during endovascular and open surgical interventions in different categories of patients with IVC thrombosis of different etiology.

Material and methods: In our clinic there is an experience of surgical treatment of 35 patients with flotating thrombosis of the inferior vena cava - in 17 of them there were true thrombotic flotations: 15 had ascending iliofemoral phlebothrombosis, and 2 had flotating thrombosis of the ovarian veins. Flotating tumor thrombi were present in 18 patients: renal cell carcinoma was present in 10 patients, uterine sarcomas in 3 patients, intravenous leiomyomatosis in 1 patient, adrenal neoplasms in 2, and retroperitoneal tumors in 2 patients. Instrumental diagnostics in these cases was based on the ultrasound examination of the IVC and its inflows, computed tomography in angio regimen of the chest, abdomen and pelvis with purposeful examination of the pulmonary artery, IVC, its tributaries, iliac veins, and as well as performing in a number of patients of cavography.

Results: The following surgical interventions were performed: cava filter implantation (OptEase, Cordis) was performed in 9 patients, thrombectomy from IVC with true thrombotic flotations in 4 patients, thrombectomy from the right chambers of the heart and / or pulmonary artery in 3 patients, removal of a tumor thrombus from IVC with application of a primary suture - in 13 patients, resection of the IVC with a tumor thrombus and distal end bandage in 2 patients, resection of the IVC and PTFE prosthesis in 1 patient. The results of surgical treatment, including mortality, the level of complications, are presented.

Conclusion: Surgical treatment of flotating thromboses of IVC has an individualized differentiated character with a preference for open-type operations.