# 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.

## Key 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.