Venous Insufficiency: Acute and Chronic

  • Seshadri Raju
  • Peter Neglèn
Conference paper

Abstract

Optimal treatment for acute deep venous thrombosis is in a state of evolution. Conventional treatment is anticoagulation with heparin followed by chronic Coumadin administration. It has been realized for some time that this treatment is not ideal, as postthrombotic malsequelae affecting the lower limbs are quite common despite adequate anticoagulation. In addition, failure of anticoagulation to provide adequate control of thromboembolism occurs in a definite percentage of patients. Killewich and associates’ recent longitudinal study of deep venous thrombosis, performed with the aid of a duplex scanner, revealed significant residual obstruction as well as reflux in the affected limbs.1 Sporadic attempts at surgical thrombectomy in the past, prompted by disenchantment with anticoagulation therapy, had yielded results that were considered no better than those produced by anticoagulation treatment. Eklof and colleagues have more recently reevaluated surgical thrombectomy, combining it with the creation of a temporary arterial-venous fistula to improve patency.2 In a carefully controlled trial, this modality was shown to be superior to anticoagulation in achieving and maintaining iliac vein patency and functional integrity of the femoral/popliteal vein segment. Superiority of the surgical option was apparent at 6 months and was maintained long-term at five years.3 The superior anatomic and functional parameters, noted with surgical thrombectomy and temporary AV fistula, translated to a reduced incidence of postthrombotic syndrome with symptom presentation and clinical manifestations in the affected patients (Figs. 36.1, 36.2, and 36.3).4

Keywords

Catheter Heparin Coumadin Beach Posite 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Killewich LA, Bedford GR, Beach KW, Strandness DE. Spontaneous lysis of deep venous thrombi: Rate and outcome. J Vasc Surg 9:89–97, 1989.PubMedGoogle Scholar
  2. 2.
    Plate G, Einarsson E, Ohlin P, Jensen R, Qvarfordt P, Eklöf B. Thrombectomy with temporary arteriovenous fistula in acute iliofemoral venous thrombosis. J Vasc Surg 1:867–876, 1984.PubMedGoogle Scholar
  3. 3.
    Plate G, Akesson H, Einarsson E, Ohlin P, Eklöf B. Long-term results of venous thrombectomy combined with a temporary arteriovenous fistula. Eur J Vasc Surg 4:483–489, 1990.PubMedCrossRefGoogle Scholar
  4. 4.
    Neglén P, Eklöf B. Thrombectomy with temporary arteriovenous fistula: the method of choice to treat acute iliofemoral venous thrombosis. In: Current Critical Problems in Vascular Surgery-III, (ed.) Frank J. Veith. St. Louis: Quality Medical Publishing, Inc. (in press).Google Scholar
  5. 5.
    Bauer G. The aetiology of leg ulcers and their treatment by resection of the popliteal vein. J Int Chir 8:937, 1948.Google Scholar
  6. 6.
    Kistner R. Surgical repair of the incompetent femoral vein valve. Arch Surg 110:1336, 1975.PubMedGoogle Scholar
  7. 7.
    Raju S. A pressure based technique for the detection of acute and chronic venous obstruction. Phlebology 3:207, 1988.Google Scholar
  8. 8.
    Raju S. New approaches to the diagnosis and treatment of venous obstruction. J Vasc Surg 4:42, 1986.PubMedGoogle Scholar
  9. 9.
    Raju S, Fredericks R. Venous obstruction: diagnosis and treatment. In: Current Critical Problems in Vascular Surgery-III, (ed.) Frank J. Veith. St. Louis: Quality Medical Publishing, Inc. (in press).Google Scholar
  10. 10.
    Raju S, Fredericks R. Hemodynamic basis of stasis ulceration—An hypothesis. J Vasc Surg 13:491, 1991.PubMedCrossRefGoogle Scholar
  11. 11.
    Raju S, Fredericks R. Valve reconstruction procedures for non-obstructive venous insufficiency: Rationale, techniques, and results in 107 procedures with 2–8 year follow-up. J Vasc Surg 7:301, 1988.PubMedGoogle Scholar
  12. 12.
    Raju S. Venous insufficiency of the lower limb and stasis ulceration: Changing concepts and management. Ann Surg 197:688, 1983.PubMedCrossRefGoogle Scholar
  13. 13.
    Kistner RL. Surgical technique of external venous valve repair. Straub Foundation Proc 55:15–16, 1990.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1992

Authors and Affiliations

  • Seshadri Raju
  • Peter Neglèn

There are no affiliations available

Personalised recommendations