Artificial graft patch reconstruction of infiltrated inferior vena cava in renal adenocarcinoma

Our understanding of fetal vascular anatomy is rudimentary. This article evaluates the rate of fetal vascular branch-point development at different gestational ages using a porcine model. The consistent biphasic, vascular branch-point development provides an improved understanding of fetal vascular anatomy, although further studies on fetal growth and the effects of anesthetic agents and vascular response to surgical techniques at the various gestational stages are needed. This will enhance fetal-maternal safety as the clinical use of fetal surgery broadens in the future.     

Congenital calcified thrombosis of inferior vena cava, bilateral renal veins and left spermatic vein

An infant with severe congenital calcified thrombosis in the inferior vena cava, bilateral renal veins and left spermatic vein is presented. Five previously published cases and pertinent points concerning this rare occurence are discussed. The etiology of this calcified thrombosis remained unknown.     

Vascular reconstruction using left renal vein graft in advanced hepatobiliary malignancy

BACKGROUND/AIMS: In surgical resection for advanced hepatobiliary malignancies involving the portal vein and inferior vena cava, vascular reconstruction is usually required. We utilized left renal vein grafts for vascular reconstruction in cases of these malignancies, and their clinical significance is evaluated in this study. METHODOLOGY: Left renal vein grafts were utilized for reconstruction of the portal vein in four patients and patch repair of the inferior vena cava was performed in two patients with advanced hepatobiliary malignancies. All six patients underwent hepatic resection with vascular resection and reconstruction. Postoperative renal function and graft patency were assessed. RESULTS: Transient slight renal disturbances appeared in some patients, but there was no severe renal dysfunction requiring specific therapy. Graft patency was maintained during the follow-up period in all patients. CONCLUSION: The use of left renal vein grafts as autovein grafts seems appropriate in cases involving reconstruction of the portal vein and in those involving patch repair of the inferior vena cava defect in surgical resection for advanced hepatobiliary malignancies.     

Anesthetic management for renal tumor extending to the inferior vena cava

A 58 year-old woman underwent radical nephrectomy, thrombectomy and ileo-cecal resection for renal tumor with thrombus involving the inferior vena cava and ascending colon cancer. In a patient having tumor thrombus extending to the vena cava, recognition of the position of the thrombus is important for surgical and anesthetic management in pre- and intra-operative periods. Transesophageal echocardiography (TEE) enabled us to visualize the real-time movement and deformity of thrombus by surgical manipulation and compression during operation. TEE seemed also very useful not only in understanding the hemodynamics during operation but also in detecting the residual tumor and the blood flow in liver and the inferior vena cava after operation.     

Leiomyosarcoma of the inferior vena cava

BACKGROUND: The inferior vena cava is an uncommon location for leiomyosarcoma, a malignant tumor which develops from the smooth muscle tissue of the media. CASE REPORT: A 76-year-old woman was hospitalized for swelling of the lower limbs. Ultrasonography, computed tomography of the abdomen and magnetic resonance imaging showed tumoral invasion of the inferior vena cava extending to the atrium. Histology examination of a tumoral fragment obtained by transjugular catheterism affirmed the diagnosis of leiomyosarcoma. DISCUSSION: Prognosis of leiomyosarcoma of the inferior vena cava is very poor. No medical or surgical treatment has given satisfactory results. Two factors would explain the poor prognosis: the tumoral localization and the low degree of tumoral differentiation. Clinical presentation and imaging findings suggest the diagnosis which must be confirmed by pathology examination of a tumoral biopsy specimen.     

Leiomyosarcoma of the inferior vena cava

1. The effects of graded dietary concentrations of cholestyramine (CSTY, a bile acid binding polymer), which prevents micelle formation and bile acid reabsorption, on the lipid and energy metabolism of chicks given diets containing different dietary concentrations of medium chain triacylglycerol (MCT) and long chain triacylglycerol (LCT) were investigated. 2. MCT- or LCT-supplemented diets containing 100 or 200 g oil/kg diet and 0, 10 or 20 g CSTY kg were fed to 7 d old chicks for 10 d. As dietary CSTY concentration increased, a reduction in the metabolisable energy value was observed for both dietary lipid sources. Consequently, fat and energy retentions were also reduced as the dietary CSTY content increased.     

Postpartum ultrasonographic diagnosis of inferior vena cava thrombus associated with ovarian vein thrombosis

Postoperative ultrasonographic assessment as a result of unremitting fever after cesarean section depicted a large pedunculated thrombus within the inferior vena cava at the level of the right renal vein. Subsequent imaging studies revealed that this thrombus was the distal extension of right ovarian vein thrombosis into the inferior vena cava.     

A study of inferior vena cava obstruction

Inferior Vena Cava obstruction as a major cause of hepatic venous outflow block is not so common. A prospective study of 20 cases gave us an opportunity to device a management protocol for this disorder. Out of 20 cases we had studied, 12 had only inferior Vena Cava obstruction while rest of the 8 cases had both hepatic vein and IVC blockade. However, balloon cavoplasty showed remarkable results with substantial clinical and haemodynamic improvement in cases with isolated IVC obstruction. Therefore, we suggest that patients with IVC obstruction should be actively managed with Vena-cavography followed by cavoplasty. Treatment of Hepatic venous obstruction along with IVC obstruction is controversial; bypass shunt is usually required and long term follow-up studies are required to establish safety and efficacy.     

Neoplastic involvement of the inferior vena cava

Inferior caval vein invasion not infrequently complicates advanced neoplastic lesions. Primitive caval neoplasms (leiomyosarcomas) or other tumors such as renal carcinomas, pheochromocytoma, as well as liver, testis, and retroperitoneal tumors most likely cause caval invasion. In the past, caval invasion was a clear index of non operability, while today, a modern multidisciplinary approach allows to treat successfully even so advanced diseases. In the present report the Authors analyze the cases treated at the Dept. of Surgery of the University of Perugia, and review the most important international reports on this subject illustrating the new possibilities offered by IVC substitution with biological or artificial grafts.