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Venous Thrombectomy

  • Gunnar Plate

Abstract

The first attempts at surgical removal of deep venous thromboses were performed during the beginning of this century.49,50,77 Larger series were presented during the late 1950s and early 1960s by Mahorner et al.,54 Haller and Abrams,34 Bradham and Buxton,6 De-Weese,17 and Fontaine and Tuchmann.27 These communications demonstrated that fatal pulmonary embolism and venous gangrene were prevented by venous thrombectomy, and the authors assumed that the late postthrombotic sequelae were also prevented. The enthusiasm for venous thrombectomy was turned into skepticism and abandonment when Lansing and Davis in 196848 presented their long-term follow-up of the series reported by Haller and Abrams, demonstrating that late sequelae and valvular incompetence had developed in the majority of the patients. Karp and Wylie,41 Mavor and Galloway,58 and Brunner and Wirth9 explained the poor long-term results by demonstrating that rethrom-bosis occurs frequently after venous thrombectomy. To avoid this complication, attempts at refining the surgical technique have continued at some institutions. Fogarty et al.26 introduced the balloon catheter, which makes venous thrombectomy easier, safer, and more effective. It should be stressed that the patients of the crucial series reported by Lansing and Davis48 were operated on without balloon catheters, which to some extent explains the disappointing results. Mavor and Galloway58 have clearly demonstrated that complete vein clearance is mandatory for continued venous patency. For this purpose, Kiely42 proposed exploration of the veins below the knee, whereas Egeblad et al.21 and Mansfield et al.56 stressed the importance of intraoperative phlebography. Postoperative local infusion of heparin or thrombolytic agents directly into the vein after thrombectomy has been advocated by some authors19,31,58,73 as a means of reducing the incidence of early rethrombosis. Based on experimental work by Kunlin47 and Bryant et al.,10 a temporary arteriovenous fistula has also been used as protection against postoperative rethrombosis.8,45,55 Some recent communications3,14,31,37,43,72,73 have demonstrated encouraging early results using variations of these new techniques for thrombectomy of iliofemoral thrombosis. All these communications lack comparison with a control group treated with conventional anticoagulation treatment, and the long-term results have not been well elucidated. In addition, the objective interpretation of the results is in many instances compromised by an insufficient number of late phlebographic examinations.

Keywords

Deep Venous Thrombosis Arteriovenous Fistula Iliac Vein Common Femoral Vein Deep venOUS Thrombosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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  • Gunnar Plate

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