Patency outcomes of primary inferior vena cava repair in radical nephrectomy and tumor thrombectomy

Harshit Garg, Philip Whalen, Haneen Marji, Robert Cooper, Furkan Dursun, Mukund Bhandari, Lokesh Khanna, Lalithapriya Jayakumar, Michael A. Liss, Robert S. Svatek, Ronald Rodriguez, Dharam Kaushik, Deepak K. Pruthi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: The reconstruction of inferior vena cava (IVC) during radical nephrectomy and venous tumor thrombectomy (RN-VTT) is mostly performed with primary repair or with a patch/graft. We sought to systematically evaluate the outcomes of IVC patency over short- to intermediate-term follow-up for patients undergoing primary repair of IVC and to assess the association with survival. Methods: A retrospective review of patients undergoing RN-VTT between January 2013 and August 2018 was conducted. Patients were followed until death, last available follow-up, or March 2022. The patency outcomes and IVC diameters were studied using follow-up cross-sectional imaging. The χ2 test, Student t test, and Kaplan-Meier survival analysis were used. Results: Seventy-seven patients were included. The mean age was 59.2 ± 12.2 years and 45.4% had Mayo classification level III thrombus or higher. At a median follow-up of 36.5 months (13.3-60.7 months), the 3-year overall survival (OS) was 64%. Sixty patients underwent primary repair of the IVC and 48 of these patients were assessed for IVC patency. Ten patients (20.8%) developed caval occlusion, either from recurrent tumor (8.3%), new-onset bland thrombus (8.3%), or stenosis (4.2). The IVC patency seemed to be a significant predictor of OS (hazard ratio, 2.85; P = .021). Although the IVC diameters decreased significantly at the 3-month postoperative scan at the infrarenal (P = .019), renal (P < .001), and suprarenal (P < .001) levels, they did not decrease further on long-term follow-up imaging. Conclusions: IVC reconstruction with primary repair results in an overall patency rate of 80.2% with only a 4.0% rate of stenosis. Recurrence of tumor thrombus (8.3%) or bland thrombus (8.3%) are the predominant reasons for IVC occlusion after RN-VTT, and this outcome is associated with poor OS.

Original languageEnglish (US)
Pages (from-to)595-604.e2
JournalJournal of Vascular Surgery: Venous and Lymphatic Disorders
Volume11
Issue number3
DOIs
StatePublished - May 2023

Keywords

  • IVC occlusion
  • IVC patency
  • Inferior vena cava repair
  • Radical nephrectomy
  • Venous tumor thrombectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Fingerprint

Dive into the research topics of 'Patency outcomes of primary inferior vena cava repair in radical nephrectomy and tumor thrombectomy'. Together they form a unique fingerprint.

Cite this