Abstract
Primary inferior vena cava (IVC) tumors are rare. Most are leiomyosarcomas. The prognosis is poor with those involving and superior to the hepatic veins faring worse than those isolated within the retrohepatic cava. Tumors with superior extension were historically considered unresectable, though there are mounting reports of multicavity resections. We present an exceedingly rare case of a primary IVC synovial sarcoma treated with caval replacement to the right atrium (without hypothermic circulatory arrest) and hepatic vein reconstruction with autologous pericardium during ante situm liver perfusion. We highlight the value of multidisciplinary consideration for extensive primary caval tumors.