THROMBECTOMY WITH ARTERIOVENOUS-FISTULA FOR EMBOLIZING DEEP VENOUS THROMBOSIS - AN ALTERNATIVE THERAPY FOR PREVENTION OF RECURRENT PULMONARY-EMBOLISM

Thrombectomy with arteriovenous fistula was performed between 1977 and 1988 in 103 patients (41 females, 62 males, mean age 46.7 years, 114 involved extremities) with embolizing deep-vein thrombosis (DVT). The sole aim of the surgical procedure was prevention of recurrent emboliz ation. On the basis of the proximal extent of the thrombosis the sourc e of embolization was identified as the iliac veins or inferior vena c ava in 63% of the patients; 48% presented with a postphlebitic vein an d/or an older thrombosis, and 46% had already had recurrent pulmonary emboli. Unsuccessful aggressive procedures had been carried out previo usly in 11%. The rate of intraoperative pulmonary embolism (PE) was 3% (one fatal case). The perioperative mortality was 6.8%, but only one death was related to the surgical treatment itself. During follow-up ( 8-140 months postoperatively, mean 55+/-34 months) late recurrent PE w as confirmed in two patients (antithrombin III deficiency, contralater al DVT) and was reported as the suspected cause of death in a third (3 .6%). Venous thrombectomy with arteriovenous fistula is a reliable and effective procedure for management of embolizing DVT and is indicated especially in young patients. The rates of early- and late-recurrent PE are low, introduction of artificial material into the vein can be a voided, and long-term preservation of valve function is occasionally p ossible.