The incremental goals that we believe are important for successful venous thrombectomy are summarized in Table 45.3. During the past two decades, the technique of venous thrombectomy has been refined and improved. Most of the principles of a successful procedure follow those established for patients undergoing arterial reconstruction for acute arterial occlusion. A number of important technical modifications have evolved, however, beginning with the accurate preoperative definition of the extent of thrombus (both proximally and distally) and whether the thrombus has embolized to the pulmonary vascular bed. The proximal extent of thrombus can be clearly defined by contralateral iliocavagraphy. It is especially important to determine

TABLE 45.2 Venous Thrombectomy with Arteriovenous Fistula: Long-Term Valve Competence of Femoropopliteal Venous Segment

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