Thrombosis of the inferior vena cava: early and late results after transperitoneal venous thrombectomy

Acute inferior vena cava thrombosis is a rare clinical feature with unknown incidence. A clear evidence about the best treatment does not exist. Espec ially the indications for surgical therapy and their clinical results are p ublished only in a few reports. So the aim of this study was to take a look to our experience and make an evaluation of the combined transcaval and tr ansfemoral venous thrombectomy. In a retrospective study of the past 12 yea rs 19 patients with a mean age of 28.5 years, 15 women and 4 men, showing a scension of a iliofemoral clot to the vena cava were treated by transperito neal and transfemoral thrombectomy. The mean thrombus age was 7 days, 2 pat ients had bilateral iliofemoral thrombosis. Simultaneously a transfemoral t hrombectomy and transcaval thrombectomy were performed after exposure of th e vena cava inferior via transabdominal approach. In all cases a venous pat ency could be achieved, 3 times a re-thrombectomy within 1 week was necessa ry. One intraabdominal hematoma was revised surgically. One patient died on the first postoperative day because of a fulminant lung embolism. After a mean follow-up of 6 years 3 patients did not have any symptoms of postthrom botic sequelae, 13 had mild and only one patient moderate postthrombotic sy ndrome. The combined transperitoneal and transfemoral venous thrombectomy o f the vena cava inferior represents a safe and effective treatment of the a cute thrombosis of the vena cava inferior. Severe postthrombotic sequelae e specially in young women may be avoided.