Vena cava defect repair using a polytetrafluoroethylene graft after a radical nephrectomy and vena cava resection: A case report

Abstract

Introduction: The gold standard treatment for large renal masses is a radical nephrec tomy and the removal of tumor thrombi from the large vessels. Here, we discussed the repair of a vena cava defect using a polytetrafluoroethylene (PTFE) graft after a radical nephrectomy and vena cava resection. Case: A 69-year-old male patient presented to our clinic with right-sided pain and 10 kg of weight loss over the previous 3 months. The computed tomography showed that the right kidney was 23 x 13 cm in size, with a 7 x 6 x 7 cm contrast-enhanced mass at the renal ilum level. The patient underwent a radical nephrectomy, and the vena cava defect was repaired using a PTFE graft. There was also tumor infiltration in the proximal third of the left renal vein. The renal vein defect was also repaired using a PTFE graft, and the end of the graft was sutured to the vena cava graft at a right angle. The histopathological examination showed a Fuhrman grade 4 renal cell carcinoma (RCC) with focal sarcomatoid differentiation areas. Conclusions: The management of patients with RCCs and inferior vena cava (IVC) tumor thrombi should be planned with an experienced team, including a cardiovascular surgeon and liver transplantation team. In these patients, the comorbidities, life expectancy, and imaging methods should be considered for treatment planning in experienced centers. The tumor stage, probability of invasion, and patient’s performance status should also be determined using magnetic resonance imaging during the preoperative period. Finally, the needs for a graft or tubular patch, sternotomy, and chemotherapeutic agents after the nephrectomy should be discussed using a multidisciplinary approach.