BACKGROUND:Renal cell carcinoma(RCC)involves the inferior vena cava(IVC)in a minority of patients.Less commonly,it presents with Budd-Chiari syndrome.If untreated, the condition progresses towards liver failure and death.METHOD:We report a case of Budd-Chiari syndrome due to infiltration of the IVC and right atrium by recurrence of RCC 7 years after successful treatment by primary resection.RESULTS:Surgery was performed with a combined abdominal and thoracic approach with cardio-pulmonary by-pass and cardioplegia.The tumor was removed and a cadaveric iliac vein graft used to re-establish venous continuity between the right atrium and hepatic veins.CONCLUSIONS:Although it is a complex and high-risk procedure,aggressive surgery performed by an experienced team with liver transplant and cardiothoracic skills may enable resection of apparently advanced caval tumors.The case is discussed in the light of the current literature. BACKGROUND: Renal cell carcinoma (RCC) involves the inferior vena cava (IVC) in a minority of patients. Loss commonly, it presents with Budd-Chiari syndrome. If untreated, the condition progresses towards liver failure and death. METHOD: We report a case of Budd-Chiari syndrome due to infiltration of the IVC and right atrium by recurrence of RCC 7 years after successful treatment by primary resection .RESULTS: Surgery was performed with a combined abdominal and thoracic approach with cardio-pulmonary by-pass and cardioplegia. The tumor was removed and a cadaveric iliac vein graft used to re-establish venous continuity between the right atrium and hepatic veins. CONCLUSIONS: Although it is a complex and high-risk procedure, aggressive surgery performed by an experienced team with liver transplant and cardiothoracic skills may enable resection of apparently advanced caval tumors. the case is discussed in the light of the current literature.