Surgical Treatment of Iliofemoral Venous Thrombosis

Abstract

The objectives of treatment in iliofemoral venous thrombosis are to prevent fatal pulmonary embolism, further swelling of the leg with development of phlegmasia caerulea dolens and the severe post-thrombotic syndrome, by preservation of venous patency and normal valves. The experience of thrombectomy and temporary AVF are presented in 155 patients where technical details of management are emphasized. A new technique with percutaneous closure of the AVF after six weeks is described. No patient died due to fatal pulmonary embolism during or immediately after surgery. In a randomized study comparing surgery with conventional anticoagulant treatment follow-up venography of the iliofemoral segment demonstrated excellent results in 76% of the operated group and 36% in the conservatively treated group, while venography of the femoropopliteal segment revealed an occlusion in about one-third of the patients in both groups. Of the patients who had an open femoropopliteal segment it was noted that 52% in the surgical group and 26% in the conservative group had preserved valves with no reflux.