Summary
The results of conventional venous thrombectomy performed in 37 patients with acute
iliofemoral thrombosis were evaluated with special reference to early postoperative
phlebography. In all patients thrombosis was verified preoperatively by angiography.
No mortality was encountered, but the leg of one patient with Phlegmasia coerulea
dolens and advanced venous gangrene had to be amputated at the above-knee level. Four
patients had pulmonary embolism in relation to surgery. Based upon postoperative phlebography,
complete clearance of all obstructed segments was achieved in 5 patients only (13.5%),
and subtotal or partial restoration resulted in 9 patients (24%). In 16 cases (43%)
postoperative phlebograms appeared equivalent to the preoperative study, and in 7
cases (20%) additional vein Segments were occluded. Despite the relatively high incidence
of recurrent thrombosis, prompt relief of Symptoms occurred in the great majority
of patients.
The more favorable angiographic results were obtained in the ilio-femoral segment;
in contrast, new occlusions were predominantly found in the popliteal-crural segments.
Restoration of a venous passage was not correlated with the duration of symptoms,
in most instances, the removed clots appeared organized and adherent tu the vein intima,
even in patients with a short clinical history. With regard to probable etiological
factors, somewhat better results were achieved for patients exposed to previous surgery
or trauma and for patients with severe medical illness. In our view indications for
venous thrombectomy should be rather restrictive;.successful clearance and long-term
patency can be expected mainly in patients with clots lying in the ilio-femoral segment
surrounded by contrast medium in the distal portion.
The results of surgical thrombectomy depend heavily upon the expertise of the performing
surgeon and can possibly be improved by newer technical modifications.
Key words
Iliofemoral venous thrombectomy - Early phlebographic results
