Raphael L C Araujo1, Sébastien Gaujoux2, Luiz Augusto Carneiro D'Albuquerque1, Alain Sauvanet2, Jacques Belghiti2, Wellington Andraus3. 1. Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil. 2. Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Beaujon Hospital, Clichy, France; University Paris 7 Denis Diderot, Paris, France. 3. Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil. Electronic address: wellington@usp.br.
Abstract
BACKGROUND: When retrohepatic inferior vena cava (IVC) resection is required, for example, for IVC leiomyosarcoma, reconstruction is recommended. This is particularly true when the renal vein confluence is resected to preserve venous outflow, including that of the right kidney. METHODS: Two patients with retrohepatic IVC leiomyosarcoma involving renal vein confluences underwent hepatectomy with en bloc IVC resection below the renal vein confluence. IVC reconstruction was not performed, but end-to-end renal vein anastomoses were, including a prosthetic graft in 1 case. RESULTS: The postoperative course was uneventful with respect to kidney function, anastomosis patency assessed using Doppler ultrasonography and computerized tomography, and transient lower limb edema. DISCUSSION: End-to-end renal vein anastomosis after a retrohepatic IVC resection including the renal vein confluence should be considered as an alternative option for preserving right kidney drainage through the left renal vein when IVC reconstruction is not possible or should be avoided.
BACKGROUND: When retrohepatic inferior vena cava (IVC) resection is required, for example, for IVC leiomyosarcoma, reconstruction is recommended. This is particularly true when the renal vein confluence is resected to preserve venous outflow, including that of the right kidney. METHODS: Two patients with retrohepatic IVC leiomyosarcoma involving renal vein confluences underwent hepatectomy with en bloc IVC resection below the renal vein confluence. IVC reconstruction was not performed, but end-to-end renal vein anastomoses were, including a prosthetic graft in 1 case. RESULTS: The postoperative course was uneventful with respect to kidney function, anastomosis patency assessed using Doppler ultrasonography and computerized tomography, and transient lower limb edema. DISCUSSION: End-to-end renal vein anastomosis after a retrohepatic IVC resection including the renal vein confluence should be considered as an alternative option for preserving right kidney drainage through the left renal vein when IVC reconstruction is not possible or should be avoided.
Authors: Rodrigo B Martino; Eserval Rocha Júnior; Valdano Manuel; Vinicius Rocha-Santos; Luis Augusto C D'Albuquerque; Wellington Andraus Journal: Am J Case Rep Date: 2017-10-11