Management of lower extremity venous
trauma using repair or
ligation has been an area of controversy during the past decades. However, in unstable patients or if primary repair is technically impossible as a result of extensive disruption of the vein,
ligation is recommended. This study investigated the effects of venous
ligation on major veins in the lower extremities when primary repair is impossible as a result of extensive
laceration of the vein. Between January 2001 and April 2004, 63 patients with Grade III and IV venous
injuries were observed prospectively. Compression ultrasonography was performed postoperatively on the fifth day, once before discharge, and at the 3-month visit to assess
deep vein thrombosis (DVT) and the patency of arterial repair. If DVT was present, the patient was given an oral
anticoagulant (
warfarin Na) for 3 months (international normalized ratio, 2.0-3.0), and Class II
compression stockings (Sigvaris-212, Ganzoni, Switzerland) were used for 1 year. Follow-up visits occurred at 1, 3, 6, and 12 months and at 6-month intervals thereafter. Combined arterial and venous
injuries were present in 50 (79.4%) patients and pure venous
injuries were present in 13 (20.6%) patients. DVT developed in 49 patients (77.7%; postoperative n = 37 [58.7%], late n = 12 [19%]). Three arterial restenoses (4.7%) and one
pseudoaneurysm (1.6%) of the superficial femoral artery developed. Five early (prophylactic) and two late (
compartment syndrome) fasciotomies were performed. Postoperative
edema was seen in 56 (88.8%) patients and
wound infection was seen in 19 patients (30.1%; n=18 superficial, n=1 deep). Two
amputations (3.2%) were performed. One patient (1.7%) died as a result of irreversible
shock. After a median of 18 months, 25 patients were classified with Clinical Etiology, Anatomy, Pathology classification: 10 legs C-0, seven legs C-2, and eight legs C-3. No severe postthrombophlebitic syndrome was observed. Early leg swelling after venous
ligation was the most common morbidity. We observed no significant sequelae of chronic
venous insufficiency, and venous
ligation had no detrimental effect on associated arterial repair. In cases of DVT, anticoagulation with
low-molecular-weight heparin and oral
anticoagulants should begin immediately and continue for 3 months along with
compression stocking support for 1 year.