Surgical, endovascular, and systemic management of renal cell carcinoma with intravascular recurrence

Renal cell carcinoma (RCC) recurrence within the vasculature represents a rare and challenging clinical scenario with limited evidence to guide management. We report a patient with clear cell RCC and level 4 IVC thrombus who underwent successful radical nephrectomy with IVC thrombectomy and subsequently developed disease recurrence in the supradiaphragmatic IVC and pulmonary arteries. Multidisciplinary management included novel endovascular removal of the recurrent IVC tumor followed by pulmonary bilobectomy for progressive tumor emboli. The patient remains without evidence of recurrent disease. This case highlights the complex multidisciplinary decision-making and potential role of minimally invasive endovascular techniques in managing intravascular RCC.