Inferior Vena Cava Resection Using Modified Veno-Venous Bypass With Renal Vein Drainage: Case Report Adapted From Liver Transplant Practice

We describe an innovative application of a modified three-arm veno-venous bypass (VVB) in the management of a complex case of recurrent renal cell carcinoma (RCC) invading the inferior vena cava (IVC) and left renal vein confluence. The patient, with a solitary kidney following right nephrectomy, underwent radical tumor resection and IVC reconstruction. To preserve renal function and minimize ischemic injury, we employed an extracorporeal circuit traditionally used in liver transplantation, adapting it to include an additional cannula in the left renal vein. This configuration allowed continuous renal venous drainage during IVC clamping, limiting kidney warm ischemia to only 14 minutes. The extracorporeal circuit included jugular and femoral venous drainage limbs connected to a centrifugal pump and a third limb providing direct renal outflow, effectively maintaining hemodynamic stability and renal perfusion. Postoperative recovery was uneventful, with transient minimal creatinine elevation and no acute kidney injury. This case demonstrates the versatility of extracorporeal venous bypass circuits in complex onco-vascular surgery and highlights the potential for broader applications of organ support technologies in preserving organ function during major vascular reconstruction. The proposed configuration represents a valuable adjunct in surgeries involving solitary kidneys and prolonged caval occlusion, bridging concepts from transplant and extracorporeal support domains.