PMC3898128_01
Computed tomography showed that there was a right renal cell carcinoma with a tumor thrombus extending to the site of the hepatic inferior vena cava (arrowheads) and that the right ureter also had a tumor thrombus (arrows)
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Fig1
A 68-year-old female was transferred to this institution with a diagnosis of right RCC with a tumor thrombus extending into the retrohepatic IVC (Fig. 1).
PMC3898128_02
Computed tomography showed that there was a giant metastatic liver tumor that directly invaded the inferior vena cava and right and middle hepatic veins. However, it could not be determined whether the tumor had invaded the left hepatic vein (arrows)
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Fig2
Left Heparin was administered, then the infrarenal abdominal aorta was clamped and the suprarenal inferior vena cava (IVC), suprahepatic IVC and left hepatic vein were clamped, as were the proper hepatic artery and portal vein. A right hepatic trisegmentectomy with resection of the invaded IVC was performed. Black arrowheads the suprahepatic and suprarenal IVC had been taped (black arrowheads). White arrows left hepatic artery, white arrowheads portal vein. Right An expansive polytetrafluoroethylene graft of 20 mm in diameter was interposed by 4-0 polypropylene continuous sutures while the infrarenal abdominal aorta was clamped. Black arrows the proximal and distal anastomosis, white arrowhead portal vein, white arrow left hepatic artery. The common bile duct had a tube inserted
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Fig3
Finally, the distal IVC and the graft were anastomosed using 4-0 polypropylene sutures, and the IVC was declamped and the infrarenal abdominal aorta was gradually declamped (Fig. 3).