VENOUS THROMBECTOMY IN ACUTE ILIAC FEMORA L VEIN-THROMBOSIS PATIENTS

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-baloon-cathete r from the proximal vessel and by bimanual exprimation from the femora l and popliteal veins. Postoperative oral anticoagulation treatment wa s attempted whenever possible, Long term results obtained in 130 patie nts after a median follow-up of 78 months (44% free of symptoms, 33% P TS [postthrombolic syndrome] I, 15% PTS II, 8% PTS III), showed a sign ificant correlation to the duration of preoperative anamnesis: less th an or equal to 5 days: 64% free of symptoms, > 5 days: 34% free of sym ptoms, the rate of PTS III was equally distributed in the group with l ong (less than or equal to 5 days) and short (> 5 days) anamnesis (8 a nd 9% respectively). Postoperative Dicumarol-therapy decreased the rat e of severe PTS: 28% without, respectively 10% with therapy. If the me dication was cancelled aggravation of the clinical symptoms in 1 third of the patients was observed. Venous thrombectomy is an important tre atment option in patients with contraindications to thrombolytic thera py. With patients younger than 65 years and short anamnesis functional results are acceptable, high risk patients (severe cardiac disease an d previous pulmonary embolism) should be treated with medical therapy only.