The authors retrospectively evaluated surgical management of 15 patients from 125 patients with acute iliofemoral DVT (6 PCD and 9 venous
gangrene) between January 1991 and August 2002 with long-term follow-up.
RESULTS: All of our 15 patients underwent surgery within 10 days of the onset of symptoms. Six patient with impending
gangrene and failure for initial management with
bed rest, extremity elevation, fluid
resuscitation, and systemic anticoagulation for six to 12 hours underwent iliofemoral venous
thrombectomy and distal
arteriovenous fistula (AVF) can preserve limbs. In nine patients with venous
gangrene that underwent iliofemoral
thrombectomy below knee had transmetatarsal
amputation done after decreasing leg
edema. All patients underwent caval filter insertion before venous
thrombectomy. There was no
pulmonary embolism (PE) or immediate mortality. Anticoagulation treatment was given for at least six months. The distal
arteriovenous fistula was closed as a secondary operation six weeks after initial operation. On the follow-up, 10-year period, seven patients died from the advanced
carcinomas 7, 9, 9, 12, 14, 18, and 20 months after an operation. The remaining eight patients have regularly followed-up over 120 months. Three patients (37.5%) had recurrence of DVT; the rate of recanalization in common iliac veins on duplex scan was 100%. Three patients (37.5%) developed reflux in at least one deep venous segment without signs and symptoms of
postphlebitic syndrome.
CONCLUSION: