Surgical strategy for management of deep venous thrombosis of the lower extremities

Clinical experience proves that there is a considerable group of patients with acute proximal deep vein thrombosis (DVT) of the legs who have absolute or relative contraindications to anticoagulants or thrombolytic agents but require immediate medical treatment. The aim here is to present our strategy for qualifying patients for venous thrombectomy and the technique of the operation in patients with acute iliofemoral DVT. A total of 268 patients with DVT were evaluated. A proximal thrombosis was diagnosed in 225 cases (84%), and acute thrombosis was found in 126 (56%) of these 225 patients. Venous thrombectomy with temporary arteriovenous fistula was performed in 30 patients. In the remaining patients initial treatment included heparin, acenocumarol, or both in 61, thrombolytic agents in 26, and other therapy in 9 cases. Three patients died during the early postoperative period. Minor nonhemorrhagic complications were observed in four operated patients. One patient developed wound hematoma. In all but three operated cases the patency of the iliac and femoral veins with leg swelling in 16 patients was observed 1 year after fistula closure. There were no episodes of rethrombosis during this period. None of the thrombectomized patient had leg ulcers. Eight patients were free of clinical symptoms related to DVT. We believe that venous thrombectomy provides a good chance for satisfactory restoration of venous outflow in patients with acute proximal DVT. Venous thrombectomy with temporary arteriovenous fistula represents the treatment of choice in patients with acute, proximal DVT and with contraindications to heparin treatment.