1. Novel Techniques for Tumor Thrombectomy for Renal Cell Carcinoma With Intraatrial Tumor Thrombus 
Ujjwal K. Chowdhury, MCh, Anand K. Mishra, MS, Amlesh Seth, MCh, Prem N. Dogra, MCh, Jayanth H.V. Honnakere, MCh, Ganapathy K. Subramaniam, MCh, Amber Malhotra, MS, Poonam Malhotra, MD, Neeti Makhija, MD, Panangipalli Venugopal, MCh 
The Annals of Thoracic Surgery 
Volume 83, Issue 5, Pages (May 2007)
DOI: /j.athoracsur
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Case 2. Magnetic resonance image (coronal section; T1-weighted image) through inferior vena cava (IVC) shows tumor completely filling the intrahepatic inferior vena cava (white arrows) and the superior extent of level IV inferior vena caval thrombus within the right atrium (RA).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Circuit diagram showing external iliac vein (EIV), superior vena cava (SVC), and ascending aortic cannulation sites and pump circuit. Note the cross-clamp sites (CC) at the level of main pulmonary artery (MPA), supraceliac segment of the abdominal aorta (AA), and infrarenal inferior vena cava (IVC). The supraceliac segment of the abdominal aorta has been exposed after dividing the right crus of the diaphragm (D).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Case 2. (A) Intraoperative photograph demonstrating the surgical maneuvers necessary for a safe and effective method of removal all tumor thrombus. For level IV extension, under cardiopulmonary bypass, a Rummel tourniquet is applied loosely around the intrapericardial inferior vena cava (IVC) above the proximal tumor (white arrow). The supraceliac abdominal aorta is clamped, after which the distal inferior vena cava, the contralateral renal vein, and finally the intrathoracic vena cava are clamped, isolating the vena cava from all venous inflow except for pooled blood within the hepatic system (not shown). (B) The liver is mobilized after transection of the falciform, coronary, and triangular ligaments. With careful dissection, using endarterectomy instruments, the tumor thrombus (T) is removed through a proximal and distal vena cavotomy. (C) Repair of the atriocaval junction (J) in progress. The abdominal aortic clamp has been released (not shown). The venous return is getting picked up by a cardiotomy sucker (S).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Case 5. Intraoperative photograph showing opened up right atrium (RA) after cardioplegic arrest. Cardiopulmonary bypass was established through cannulas in the superior vena cava, right external iliac vein, and ascending aorta (not shown). After right atriotomy the intraatrial portion of the tumor (T) was visualized and excised. Using endarterectomy instruments and an index finger, the surgeon freed the tumor thrombus from the cavoatrial junction, hepatic veins, and inferior vena cava, and using gentle traction the surgeon delivered the tumor through the vena cavotomy.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions