The Surgeon at Work Resection of Tumors of the Pararenal Inferior Vena Cava with In Situ Perfusion of the Right Kidney and Graft Replacement with Bovine Pericardium

We describe a technique of total resection of the pararenal inferior vena cava (IVC) with single perfusion of the right kidney, preservation of the left gonadal and adrenal veins, and reconstruction of the IVC with glutaraldehyde-treated bovine pericardium in a patient with a leiomysarcoma of the IVC. We believe that this technique is safe, can be performed without jeopardizing renal function or hermodynamic stability, and longterm graft patency can be obtained. It is recommended particularly for patients with primary or secondary tumors of the pararenal or suprarenal IVC who require resection. Leiomyosarcomas of the inferior vena cava (IVC) are rare tumors. A recent review by Mignoli and associates, who established an International Registry of Inferior Vena Cava Leiomyosarcomas, collected 218 patients. Radical resection is the treatment of choice because it potentially offers longterm cure. For infrarenal IVC tumors, several procedures have been described and the technique is well standardized. For lesions localized at the pararenal or suprarenal IVC, the procedure remains a surgical challenge for anatomic reasons. Several forms of management have been described, including resection and IVC ligation, wedge resection with simple closure or patch reconstruction instead of replacement, assisted resection with venovenous bypass, and radical resection with kidney autotransplantation. Several prosthetic grafts have been used to replace the IVC, with variable results. We report the surgical technique of replacing the pararenal IVC with selective in situ perfusion of the right kidney and graft replacement with glutaraldehyde-treated bovine pericardium in a patient with primary leiomyosarcoma of the IVC.