Surgical Thrombectomy

Surgical thrombectomy with distal arteriovenous fistula creation for acute DVT is mainly of historical interest because of its associated operative morbidity primarily related to blood loss and poor clinical outcomes. However, surgical thrombectomy may still be used in the clinical setting of venous gangrene with impending limb loss. The best reported results are from a 1999 study by Juhan et al.15 These authors demonstrated an improvement in long-term results following surgical venous thrombectomy for acute iliofemoral DVT in their personal series.15 In a review of 77 patients, principally young trauma victims, valvular competency was preserved at five years in 80%, and 90% of limbs had either mild symptoms of chronic venous insufficiency or no symptoms at all. Additionally, Meissner and colleagues reported their results of venous thrombectomy with arteriovenous fistula in 30 patients.16 In all but three patients, patency of the iliofemoral segment was maintained 12 months after clot extraction. However, other series have demonstrated only average results for this all but abandoned technique.

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