Results Of Operative Venous Thrombectomy

Although the early mortality rate in Haller and Abrams series was 9%, with two of the three fatalities attributed to PE, by the mid-1980s a progressive reduction in operative mortality was observed. Eklof and Juhan19 reported their large experience in 230 patients undergoing venous throm-bectomy for iliofemoral venous thrombosis. They reported no fatal PE and only one operative death. It is apparent that the application of venous thrombectomy now can be based on its effectiveness relative to competitive forms of therapy in reducing early morbidity and the late sequelae of ilio-femoral venous thrombosis, rather than on the concern that the procedure will fail or be accompanied by complications.

Successful venous thrombectomy significantly reduces early morbidity in patients with phlegmasia cerulea dolens and phlegmasia alba dolens. The patients' pain and edema quickly subside and the discoloration resolves. The definition of benefit, however, may be masked by the additional cost of the operation, the need for blood transfusion, inci-sional discomfort, and wound complications. Interestingly, even if thrombectomy is not complete or is followed by some degree of rethrombosis, the limb rarely returns to its former morbid state if elevation and anticoagulation are

TABLE 45.1 Venous Thrombectomy with Arteriovenous Fistula: Long-Term Iliac Vein Patency
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