Therapy of deep vein thrombosis of the leg. When to operate on?

In spite of quite a few clinical trials the benefit of venous thrombectomy is seen controversely. The primary objectives of treating venous thrombosis are survival rate, prevention of pulmonary embolism and of postthrombotic syndrome. We report our experience with 47 patients who underwent venous th rombectomy. The mortality rate was 0%. We did not observe clinically releva nt pulmonary embolism. After two years 90% of thrombectomised veins were pa tent. The mortality rates given in the literature of conservative treatment with heparin and following oral anticoagulation are 0.4 to 1.6%. Fibrinoly sis shows mortality rates of 1 to 2.4, and thrombectomy of 3.8%, respective ly. Venous thrombectomy is an effective treatment to prevent pulmonary embo lism. In our own experience we saw no clinically significant pulmonary even t. The danger of embolism rises with the proximity of the venous thrombus. Therefore those patients may have the greatest potential benefit from throm bectomy who present with a mobile inguinal thrombus or a thrombus in the il iac vein. So far there are no statistically sufficient data to support the indication of thrombectomy to prevent a postthrombotic syndrome.