If your vet suggested that there was a good chance of extensive hemorrhage
in this case, then it is probably best that he did not proceed.  A man has
to know his limitations, and it is far better that he pulled out rather
than to perform a risky procedure.
 
As a general rule - in these cases, caval ligation is often of benefit.  In
some cases, caval blockage of only 50% may be enough to develop an adequate
level of collateral circulation.  However, this is a salvage operation, and
is associated with about a 15% mortality.  There is little way to determine
whether adequate collateral circulation has occurred before the cava is
ligated - it is based on an educated assessment of the situation and
knowing that there are few other options.
 
Cryosurgery is another possibility - the use of the cryoprobe is associated
with less risk than a scalpel blade when used in proximity to the cava -
vessels are relatively resistant to the freezing technique.  However, with
this procedure, there is a higher chance that the malignancy will not be
completely removed, especially if it goes around and under the cava.
 
The use of a vascular microsurgeon may be another viable way to approach
the problem - these specialists are generally not available to all,
necessitating the use of the other techniques.
 
You can't fault your vet for knowing when to call in the cavalry - I know
you and Florian all want the best outcome for this surgical procedure.
 
With kindest regards,
Bruce Williams, DVM
[Posted in FML issue 3476]