Hw. Kniemeyer et al., THROMBECTOMY WITH ARTERIOVENOUS-FISTULA FOR EMBOLIZING DEEP VENOUS THROMBOSIS - AN ALTERNATIVE THERAPY FOR PREVENTION OF RECURRENT PULMONARY-EMBOLISM, The Clinical investigator, 72(1), 1993, pp. 40-45
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.