LONG-TERM FOLLOW-UP OF PATIENTS WITH TUMOR THROMBI FROM RENAL-CELL CARCINOMA AND TOTAL REPLACEMENT OF THE INFERIOR VENA-CAVA USING AN EXPANDED POLYTETRAFLUOROETHYLENE TUBULAR GRAFT

Purpose: Inferior vena caval resection and its reconstruction are some times necessary when the inferior vena cava is extensively involved by a large and fixed tumor thrombus from renal cell carcinoma or other m alignancies, We successfully replaced the inferior vena cava using tub ular expanded polytetrafluoroethylene (Teflon) vascular grafts after e n bloc removal of the tumor thrombus and inferior vena cava. We follow ed the patients long term and observed inferior vena caval patency. Ma terials and Methods: The 3 men and 2 women ranged from 42 to 75 years old, The renal tumors were on the right side in 4 patients and asynchr onously bilateral in 1, The suprarenal inferior vena cava was replaced in 3 patients and the infrarenal portion was replaced in 2, The expan ded polytetrafluoroethylene tube grafts, 18 to 22 mm. in diameter and 5 to 12 cm. long, were externally stented in 3 patients and not stente d in 2. Results: Followup ranged from 6 to 96 months (mean 58). Long-t erm patency of the graft was maintained in all patients. Of the patien ts 3 had no evidence of disease at 6 months and 2 died of recurrent tu mor at 6 and 84 months. Conclusions: Total replacement of the inferior vena cava using an expanded polytetrafluoroethylene tubular graft may offer a feasible method with good patency rates in the long term.