Right Kidney Preservation During Resection of the Infrarenal Inferior Vena Cava for Paragangliomas.

Background: In the case of tumors involving the infrarenal inferior vena cava (IVC), reimplantation of both renal veins is recommended to preserve renal function. The left renal vein can be ligated because of the collateral circulation through the gonadal and/or lumbar veins. On the contrary, right nephrectomy or reconstruction of the right renal vein (when not invaded) is mostly performed because the right kidney has no collateral vein circulation ^1,2.

Patients and methods: The patient had a paracaval paraganglioma infiltrating the infrarenal IVC. The confluence of both renal veins was infiltrated, and incomplete surgery had been performed previously. Preoperative imaging showed that the right renal vein was free from tumoral infiltration at the renal hilum. Surgery was performed via a midline incision. To avoid venous congestion a temporary venous shunt between the right renal vein and the portal vein was used². The IVC was resected en-bloc with the both renal veins and reconstructed by a 10 cm long, 20 mm diameter, ringed Goretex® tube. The right renal vein was reimplanted directly over the IVC tube. The left renal vein was anastomosed on the IVC tube by interposing a 5 cm long, 10 mm diameter, ringed Goretex® tube.

Results: The postoperative course was uneventful. Long-term imaging showed permeability of the IVC and right renal vein reconstruction, but obstruction of the conduit used to replace the left renal vein, which was drained via the left gonadal vein. No tumoral recurrence was detected.

Conclusions: Resection of the infrarenal IVC with preservation of both renal veins can be feasible in selected cases. To avoid venous congestion, a temporary venous shunt between the right renal vein and the portal vein can be useful.