Total Endovascular Iliocaval Reconstruction Using Polytetrafluoroethylene Stent-Graft Placement for the Treatment of Inferior Vena Cava Resection

Resection of the inferior vena cava (IVC) is a rare surgical technique that is occasionally combined with nephrectomy in the setting of renal malignancy with intravascular tumor extension. While this may be fairly well tolerated in some patients due to extensive collateralization in the venous system, there is a clear potential for lower extremity venous insufficiency and deep vein thrombosis (DVT). This report describes a patient who underwent right nephrectomy and segmental IVC resection from the subhepatic space to the iliac confluence, which was complicated by profoundly symptomatic lower extremity DVT and gastrointestinal hemorrhage due to system-to-portal shunting. After performing sharp recanalization through the retroperitoneum, iliocaval reconstruction was accomplished utilizing covered stent-grafts, with complete resolution of symptoms.