[Surgical therapy of acute thrombosis of leg-pelvic veins]

A series of 213 consecutive patients suffering from acute iliofemoral vein thrombosis who underwent venous thrombectomy is analyzed. Surgery was performed from an inguinal approach with a Fogarty-balloon-catheter from the proximal vessel and by bimanual exprimation from the femoral and popliteal veins. Post-operative oral anticoagulation treatment was attempted whenever possible. Long term results obtained in 130 patients after a median follow-up of 78 months (44% free of symptoms, 33% PTS [postthrombolic syndrome] I, 15% PTS II, 8% PTS III) showed a significant correlation to the duration of preoperative anamnesis: < or = 5 days: 64% free of symptoms, > 5 days: 34% free of symptoms, the rate of PTS III was equally distributed in the group with long (< or = 5 days) and short (> 5 days) anamnesis (8 and 9% respectively). Postoperative Dicumarol-therapy decreased the rate of severe PTS: 28% without, respectively 10% with therapy. If the medication was cancelled aggravation of the clinical symptoms in 1 third of the patients was observed. Venous thrombectomy is an important treatment option in patients with contraindications to thrombolytic therapy. With patients younger than 65 years and short anamnesis functional results are acceptable, high risk patients (severe cardiac disease and previous pulmonary embolism) should be treated with medical therapy only.