SURGERY IN ACUTE AND CHRONIC VENOUS DISEASE

  • 1 January 1979
    • journal article
    • research article
    • Vol. 85  (1) , 31-43
Abstract
A favorable experience with 140 cases of surgical intervention in deep venous disease of the lower extremity, divided between acute and chronic problems, is described. Of these, 107 were treated for acute phlebitis, 33 for deep venous insufficiency and 77 cases of acute iliofemoral phlebitis underwent thrombectomy. Preoperative venography was done in all, and postoperative venography was done in 57 patients. Of these, 75% had patent iliofemoral segments after a modified surgical approach. A positive correlation was found between the degree of adherence of the iliofemoral clot and the postoperative patency rate; this usually can be predicted from preoperative venographic findings. Clinical follow-up averages 4 yr and extends to 11 yr. Ligation and division of the superficial femoral vein, indicated by preoperative venography, was the sole procedure in 30 patients with acute deep venous thrombosis and in 5 with deep vein insufficiency. It was successful as a means to control emboli in selected cases. Long-term ill-effects were minimal. In chronic severe venous insufficiency, surgery has expanded applications. Ligation of incompetent veins, reconstruction of valves and anastomosis of major segments of the femoral system are presented with preoperative and postoperative studies. Postoperative thrombosis was not a problem. Specific procedures to remedy chronic problems of the deep venous system are presented.

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