Introduction Mechanistic methods for preventing fatal pulmonary infarction due to thromboembolism have challenged the imagination of surgeons since Trendelenberg first proposed pulmonary embolectomy in 1908.30Ligation of femoral veins, first proposed by Homans in 193411has been subjected to extensive trial and study and has been found wanting.4,13,17Iliofemoral thrombectomy, introduced by Läwen in 1938,16is currently experiencing a rebirth of interest and may be effective in acute processes.5,10Permanent ligation of the vena cava, also first suggested by Homans12in 1944, has most successfully withstood the test of time and has undoubtedly saved many lives.23 Although some surgeons15,23minimize its importance, many patients experience significant postligation ulceration or edema after caval ligation.26This has provoked other investigators to continue their search for a better method. Streuter and Paine (1951),29Pualwan et al (1954),24and Dale (1958)3presented