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

TL;DR

A patient with kidney cancer and a blood clot in a major vein had a life-threatening complication during surgery, requiring emergency treatments but ultimately died from severe bleeding and clotting issues.

Contribution

This case report highlights the rare and complex management of intraoperative tumor migration and thrombus during renal tumor surgery.

Findings

Intraoperative tumor migration occurred during renal tumor excision.

Veno-arterial ECMO and mechanical thrombectomy with FlowTriever were used to manage the complication.

The patient succumbed to massive hemorrhage and disseminated intravascular coagulopathy.

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.

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