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Successful surgical therapy with vena cava-venectomy of a pheochromocytoma
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An 11 yr old spayed female Labrador retriever was diagnosed with a right adrenal tumor. At surgery, adhesions to the right kidney were dissected, allowing the right kidney to be preserved. The tumor showed extensive invasion into the suprarenal vena cava. It was felt that thrombus removal via venotomy could not be performed. Instead, the vena cava was ligated caudal to the liver and cranial to the right renal vein. A real challenge for the surgeon!
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The neoplastic gland was then excised en bloc together with the portion of the invaded caudal vena cava.
Hind limb edema had developed preoperatively and increased transiently in the first days postoperatively.
The animal was discharged 6 days postoperatively with no other clinical disorders, and hind limb edema resolved over time.
Histopathology identified a pheochromocytoma.
The dog died 49 mo later.
A neoplastic thrombus of the vena cava may require venotomy to allow thrombus removal.
Occasionally, removal of the thrombus by venotomy may prove impossible.
In such a situation, en bloc removal of the concerned portion of the vena cava may be performed with a good long-term outcome provided that gradual occlusion of the vena cava by the thrombus has allowed time for collateral circulation to develop.
Source: Pierre J. Guillaumot, Dominique Heripret, Bernard M. Bouvy, Gilbert Christiaens, Agnes Poujade, Maxence Delverdier, Cyrill Poncet (2012): 49-Month Survival Following Caval Venectomy Without Nephrectomy in a Dog with a Pheochromocytoma. In: Published online before print July 27, 2012, doi: 10.5326/JAAHA-MS-5788
Journal of the American Animal Hospital Association Sep/Oct 2012 jaaha.5788
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