Cavoatrial Shunt for IVC Obstruction by Organized Thrombosis

ABSTRACT

Suprarenal IVC obstruction occurs rarely but has various causes. Because this obstruction proceed chronically and usually has collateral circulation, if there is no IVC or hepatic vein obstruction symptom such as Budd-Chiari syndrome, operation is usually needless. However, although symptom is not combined, if malignancy can not be ruled out and there is no proper and radiologically visible collateral, mass resection with IVC wall and bypass graft should be done. 58 year-old female patient visit the hospital for IVC mass that is occasionally discovered by routine abdominal ultrasonography examination. After abdominal CT scanning and IVC venography, IVC obstructive mass between renal vein and hepatic vein was found. Patient didn't show any abnormality in hematological examination such as coagulation and platelet counts. There was no IVC obstruction symptom such as lower limb swelling. Inferior hepatic vein was abnormally dilated and this was regarded as collateral vessel for IVC obstruction. Radiologically, primary leiomyosarcoma was not ruled out and so operation was decided. Suprarenal IVC was dissected and mass was exposed. And with the use of femoral vein and right atrium, temporally veno-veno bypass was performed. Mass including IVC wall was excised and upper end of divided IVC was sutured. Lower end of divided IVC was anastomosed with 16 mm Dacron graft and graft was anastomosed with right atrium by end-to-end methods (Cavoatrial shunt). Postoperative pathologic examination revealed the mass to be organized thrombi. After 2 weeks later, follow-up IVC venography was performed and good patency was found from IVC to right atrium through artificial bypass graft and patient was discharged without complications.