Novel Use of AngioVac System to Prevent Pulmonary Embolism during Radical Nephrectomy with Inferior Vena Cava Thrombectomy

Venous tumor thrombus occurs in 5-10% of patients with renal cell carcinoma. Surgical excision offers the best chance for survival, but is technically difficult. Risk of pulmonary embolism from venous thrombus or tumor thrombus is high, especially with tumors located higher in the inferior vena cava. Cardiopulmonary bypass may be used when a tumor extends above the diaphragm, but carries significant risk. We present an 86-year-old woman with a 7 cm renal mass extending into the inferior vena cava just below the confluence of the hepatic vessels. Prior to surgery she was found to have increasing pulmonary embolisms despite appropriate anticoagulation. Intraoperatively, the AngioVac aspiration system was utilized to prevent further pulmonary embolism. This is the first reported case of the use of this system during radical nephrectomy.