118 - Endovascular Management of Tumor Thrombus: Comprehensive Analysis of Mechanical Thrombectomy and Interventional Strategies Across Cancer Types

Monday, April 13, 2026

4:21 PM - 4:30 PM ET

Presenting Author(s)

Satya K. Morar, MS (he/him/his)

Medical Student
Case Western Reserve University School of Medicine, United States

Author/Co-author(s)

DV

Devi Preetham R. Veeramgari (he/him/his)

Medical Student
Virginia Commonwealth University School of Medicine, United States
Charles Martin, III, MD, FSIR, MBA (he/him/his)

Staff Physician
Cleveland Clinic Foundation, United States

Purpose: To evaluate endovascular treatment strategies for tumor thrombus across different cancer types, focusing on mechanical thrombectomy, catheter-directed interventions, and combined approaches for hepatocellular carcinoma, renal cell carcinoma, and other solid tumors with venous extension.

Materials and Methods: Systematic review of 89 patients from 12 institutions (2015-2024) with tumor thrombus treated endovascularly. Cancer types included renal cell carcinoma (n = 42), hepatocellular carcinoma (n = 31), and other malignancies (n = 16). Interventions included mechanical thrombectomy, aspiration techniques, balloon occlusion, and combination therapies. Primary endpoints were technical success, symptom relief, and progression-free survival.

Results: Technical success was achieved in 91.0% of procedures. For renal cell carcinoma with IVC thrombus, mechanical thrombectomy demonstrated 95.2% success with a median procedure time of 68 minutes and minimal blood loss (mean 85mL). Complete thrombus removal was achieved in 83.3% of cases. Hepatocellular carcinoma with portal vein thrombus demonstrated 87.1% technical success, accompanied by significant symptom relief in 74.2% of patients. Major complications occurred in 6.7% of cases, including pulmonary embolism (3.4%) and vessel perforation (2.2%). Six-month progression-free survival was 67.4% for RCC and 42.9% for HCC. Combined endovascular-surgical approaches yielded superior outcomes compared to endovascular treatment alone (p < 0.01).

Conclusion: Endovascular management of tumor thrombus provides effective palliation with acceptable morbidity across multiple cancer types. Mechanical thrombectomy offers rapid symptom relief with minimal invasiveness compared to surgical alternatives. Combined endovascular and surgical approaches optimize outcomes, particularly for high-level renal tumor thrombi. Patient selection and multidisciplinary planning remain crucial for optimal results.