Caval ligation versus clipping to counteract pulmonary embolism

In 1967-1983 31 patients underwent surgical interruption of the inferior vena cava (IIVC) with ligation, and in 1984-1985 five patients were treated by IIVC with clipping (Adams-de Weese clip). The early adverse effects in the legs and complications were studied, and all five IIVC patients with clipping underwent isotope phlebography. The most serious early complication was sudden death on the 9th postoperative day after ligation. In one half of the affected legs moderate or severe oedema was found after the ligation. After clipping early adverse effects in the legs were minimal, and isotope phlebography showed an open inferior vena cava in all cases; only in one patient were collateral veins found past the inferior cava. It is concluded that when IIVC is indicated clipping is the optimal surgical method. IIVC with ligation is indicated only in septic embolism.