Resection of pheochromocytoma is associated with potential risks of hypertensive crises and serious arrhythmias due to massive release of catecholamines from the tumor. We report our surgical experience with complete inferior vena caval isolation and extracorporeal charcoal hemoperfusion (IVCI-CHP), which were performed to prevent systemic exposure to catecholamines during surgical manipulation. The IVCI-CHP significantly reduced the postfilter and systemic catecholamine levels compared with the prefilter levels (P<.01), indicating substantial catecholamine extraction (>90%) by the CHP filter. Reflecting the reduction of systemic exposure to catecholamines during IVCI-CHP, the patient's blood pressures were markedly stable. Our findings suggest that IVCI-CHP may be useful to minimize the risk of hypertensive crises during surgical manipulation of pheochromocytoma, by preventing systemic exposure to high levels of circulatory catecholamines.