Surgical treatment of acute deep vein thrombosis (pp. 125-132)
Authors: (Tomohiro Ogawa)
Abstract: The ilio-femoral venous thrombosis has higher risks of fatal pulmonary embolism, severe pain and swelling, moreover developing ischemia of the affected leg. In addition, the disabling post-thrombotic syndrome (PTS) which causes the pain, swelling, pigmentation or ulceration of legs is often found as late complications. The anticoagulant therapy is a widely accepted treatment for acute deep vein thrombosis to prevent pulmonary embolism and recurrent deep vein thrombosis with strong evidence. However, the results of anticoagulants are not always satisfied from the points of eliminating patientís complaints quickly and further prevention of PTS. Several reports show that the early removal of venous thrombus plays an important role of maintaining venous valvular competence and preventing PTS. So catheter-directed thrombolysis (CDT) and surgical thrombectomy, which can be expected, and early
removal of venous thrombus are considered aggressive treatments of ilio-femoral venous thrombosis to relieve symptom quickly and prevent post-thrombotic syndrome more than anticoagulant therapy alone. Since the excellent thrombolytic result of CDT was reported with less invasive, venous thrombectomy is becoming an alternative method of CDT. Currently, the surgical thrombectomy tends to be indicated for mobilized patients who have acute ilio-femoral thrombus with the contraindication or failure of thrombolysis.
Thrombectomy for ilio-femoral venous thrombosis is approached from the common femoral vein using a Fogarty catheter and manual massage under general anesthesia with the protection of peri-operative pulmonary thromboembolism. The construction of temporary A-V fistula and additional endovenous procedures such as stenting for the stenotic iliac vein are recommended to maintain the patency of the ilio-femoral vein.
Previous reports show the early and late results of surgical thrombectomy with selected indications are fairly good. The surgical thrombectomy is still an option for the treatment of severe acute ilio-femoral vein thrombosis.