Cavoatrial tumor thrombus

The four stages of cavoatrial tumor extension are depicted. In type I and II disease, tumor excision can be safely achieved by means of simple proximal and distal control of the inferior vena cava, while for type III and IV disease, exposure and isolation of the inferior vena cava is more extensive, requiring liver mobilization with or without the use of cardiopulmonary bypass and, in some circumstances, deep hypothermic circulatory arrest.