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Case Reports
. 2024 Aug 26;16(8):e67852.
doi: 10.7759/cureus.67852. eCollection 2024 Aug.

Intraoperative Tumor Migration During Renal Tumor Excision, Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO), and Mechanical Thrombectomy with FlowTriever

Arvind Sivashanmugam  1   2 , Alexander S Doyal  3 , Darvinash Chandra Mohan  3 , Katy Reines  4 , Ricardo A Serrano  3
Affiliations
Case Reports

Intraoperative Tumor Migration During Renal Tumor Excision, Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO), and Mechanical Thrombectomy with FlowTriever

Arvind Sivashanmugam et al. Cureus. .

Abstract

We describe a case of a 76-year-old male with stage 3 renal cell carcinoma and known thrombus burden in his inferior vena cava (IVC) who presented for a scheduled radical right open nephrectomy with regional lymph node dissection and IVC thrombectomy. During this procedure, the patient went into pulseless-electrical activity. A trans-esophageal echocardiogram showed thrombus transit into the right atria. Emergent initiation of veno-arterial extracorporeal membrane oxygenation and mechanical embolectomy using a FlowTriever retrieval catheter was required. The patient remained intubated in critical but stable condition. Shortly afterward, he expired due to subsequent complications of massive hemorrhage and disseminated intravascular coagulopathy.

Keywords: aspiration thrombectomy; flowtriever; intraoperative cardiac arrest; pulmonary embolism; renal cell carcinoma; transesophageal echo; tumor migration; va-ecmo.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT Abdomen/Pelvis Image Showing the Right Renal Mass
Figure 2
Figure 2. CT Abdomen/Pelvis Image Showing the Right Vein Tumor and IVC Thrombus
IVC: Inferior vena cava
Figure 3
Figure 3. MRI Image Showing Renal Cell Carcinoma
Figure 4
Figure 4. MRI Image Showing IVC Tumor Thrombus
IVC: Inferior vena cava
Figure 5
Figure 5. TEE Image Showing the Presence of a Clot in the Right Atria
TEE: Trans-esophageal echocardiogram
Figure 6
Figure 6. TEE Image Showing the Presence of a Clot in the Right Atria
TEE: Trans-esophageal echocardiogram
Figure 7
Figure 7. Removed Clot Burden from FlowTriever
See this image and copyright information in PMC

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