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Caval ligation versus clipping to counteract pulmonary embolism
Annales Chirurgiae Et Gynaecologiae
|January 1, 1986
Summary
Surgical interruption of the inferior vena cava (IIVC) using clipping is safer than ligation, causing fewer leg complications. Ligation is only recommended for septic embolism cases.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Inferior Vena Cava Interruption
Background:
- Surgical interruption of the inferior vena cava (IIVC) is a procedure to prevent pulmonary embolism.
- Historically, ligation was the primary method, but concerns about complications have led to the development of alternative techniques.
Purpose of the Study:
- To compare the early adverse effects and complications of surgical interruption of the inferior vena cava (IIVC) using ligation versus clipping.
- To determine the optimal surgical method for IIVC based on patient outcomes.
Main Methods:
- Retrospective review of 31 patients who underwent IIVC with ligation (1967-1983).
- Prospective study of 5 patients who underwent IIVC with clipping (1984-1985).
- Assessment of early leg adverse effects, complications, and isotope phlebography in clipped patients.
Main Results:
- The most serious complication was sudden death on postoperative day 9 after ligation.
- Moderate to severe leg edema occurred in 50% of patients following ligation.
- Patients undergoing IIVC with clipping experienced minimal early leg adverse effects, with isotope phlebography showing an open inferior vena cava in all cases.
Conclusions:
- Clipping is the optimal surgical method for inferior vena cava interruption when indicated.
- Inferior vena cava interruption with ligation is reserved only for cases of septic embolism.