[Treatment concept in deep pelvic-leg venous thrombosis]

The treatment of choice in acute deep vein thrombosis continues to be controversial. Conservative treatment with heparin and anticoagulation, systemic thrombolysis, thrombectomy and the combination of local thrombolysis and surgical unblocking are possible therapies. Regarding long term results; both after non operative treatment or after venous thrombectomy, many authors describe a majority of patients who suffer from chronic venous insufficiency in varying clinical severity. Requirements for normal venous function are complete phlebographic patency and valvular competence without venous reflux. Our proposed treatment for thromboses not older than 7 days combines local thrombolysis with venous thrombectomy to achieve these requirements and contains the following operative proceeding: An incision is made in the groin or - for more distal thromboses - on the proximal end of the clot. For the removal of the clot in the iliac vein a Fogarty-catheter is used. Urokinase is administered through a vein puncture in the instep while the blood flow is blocked by a pneumatic cuff around the thigh. After at least 20-30 minutes the clots can be removed through the proximal incision after removal of the cuff and manual massage of the leg. During this procedure the vein proximal of the venotomy is occluded by a soft clamp. An analysis of the results of 34 patients on average 3 1/2 years after combined therapy confirms normal valvular function of the popliteal vein in 27 (79%) cases. This improved long term outcome is going to be checked in an prospective study evaluating anticoagulation versus our treatment concept.