Cavoatrial Thrombectomy without the Use of Cardiopulmonary Bypass for Abdominal Tumors. Our Experience and State of the Art Emilio Vicente, Yolanda Quijano, Benedetto Ielpo, Giuseppe Massimiliano De Luca, Antonio Prestera, Hipolito Duran, Eduardo Diaz, Isabel Fabra, Sergio Olivares, and Riccardo Caruso, Madrid, Spain Background: Surgical resection of a tumor with thrombus formation extending from the inferior vena cava (IVC) to the right atrium can be performed without the use of a cardiopulmonary bypass. However, this technique is not widely known or used by general surgeons. Our aim was to present our experience in a general surgical unit setting and to present a literature review. Methods: Retrospective analysis of 3 cases with successful cavoatrial thrombectomy without the use of cardiopulmonary bypass by a transabdominal, transdiaphragmatic, and transpericar- dic approach. We also performed a review of the English literature of this procedure. Results: Three cases are presented: right-sided hepatocellular carcinoma, a right renal carci- noma, and a recurrent hepatic hydatid cyst all which required surgery. An approach from the right atrium to the IVC was used, and then, after cavoatrial occlusion, a cavotomy was performed to carry out the thrombectomy. In all cases, a transesophageal echocardiography was per- formed during surgery. We only found 6 other similar cases that were performed successfully in current medical literature. Conclusions: Our own experiences and cases identified through a literature review demon- strate that a thrombectomy for IVC thrombus in the setting of abdominal pathology can be per- formed successfully in selected cases without the support of cardiopulmonary bypass. Abdominal tumors associated with thrombus for- mation in the inferior vena cava (IVC) are often linked to a poor prognosis, especially if the thrombus extends to the right atrium (RA). Com- plete surgical resection of tumor and thrombus is considered to be the only possible treatment. How- ever, this is a challenging procedure for the surgeon because of its high rates of postoperative morbidity and mortality. 1 Normally, a sternotomy or thoracot- omy is necessary, using an extracorporeal cardiopul- monary bypass (CPB) to perform intrathoracic IVC isolation and to finally remove the thrombus pre- venting formation of emboli. 2 However, this proce- dure is both complex and associated with a high postoperative risk to the CPB and circulatory arrest. Given this high risk, a few surgeons have suggested alternative approaches to this dilemma, avoiding thoracic access and CPB, therefore reducing postop- erative morbidity and mortality. Cardiac and thoracic surgeons traditionally perform supradiaph- ragmatic IVC surgery, and therefore, as a result, most general surgeons are still not familiar with these procedures. In this article, we will report the experience that we have had with tumor resections using IVC thrombectomy without a requirement for CPB. Furthermore, we have completed a literature review for the procedure, which, as far as we are aware, is the first to be reported. Conflicts of Interest: The authors declare no conflicts of interest. General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Madrid, Spain. Correspondence to: Benedetto Ielpo, General Surgery Department, Sanchinarro University Hospital, San Pablo University of Madrid, Calle O~ na 10, 28050, Madrid, Spain; E-mail: ielpo.b@gmail.com Ann Vasc Surg 2015; 29: 1020.e1–1020.e5 http://dx.doi.org/10.1016/j.avsg.2015.01.021 Ó 2015 Elsevier Inc. All rights reserved. Manuscript received: August 20, 2014; manuscript accepted: January 20, 2015; published online: March 11, 2015. 1020.e1