Although
venous thrombosis (
thrombophlebitis) is well known, there are uncommon manifestations which are seen infrequently, discussed rarely, and documented poorly. Experiences with 38 patients in seven categories are discussed in terms of our results and the pertinent reports of others. Pulmonary
necrosis after embolic
pulmonary infarction (six patients) may require tube
thoracotomy and/or lung resection and contraindicate further
heparin therapy. Iliac and/or femoral vein
thrombosis occasionally fails to recanalize. Long-standing occlusion (18 patients) may be benefited by a cross-over saphenous vein graft. Left iliac venous occlusion secondary to pressure from the crossing right iliac artery (four patients) may indicate repair or bypass.
Budd-Chiari syndrome (
thrombosis of the hepatic venous outflow) was, in a single patient, carried past a critical period by a long
Dacron tube shunt graft from the umbilical vein to the azygos vein. Subclavian and axillary
venous thrombosis due to thoracic outlet pressure syndrome (three patients) often responds to
heparin but may require
thrombectomy; later resection of the first rib is indicated. Phlegmasia cerulea dolens (blue
phlebitis) with tissue
gangrene (three patients) requires immediate venous
thrombectomy and subsequent heparinization. The occluded inferior vena cava (three patients) remains a challenging unsolved problem.