Thrombectomy with arteriovenous fistula for embolizing deep venous thrombosis: an alternative therapy for prevention of recurrent pulmonary embolism

Abstract

Thrombectomy with arteriovenous fistula was performed between 1977 and 1988 in 103 patients (41 females, 62 males, mean age 46.7 years, 114 involved extremities) with embolizing deep-vein thrombosis (DVT). The sole aim of the surgical procedure was prevention of recurrent embolization. On the basis of the proximal extent of the thrombosis the source of embolization was identified as the iliac veins or inferior vena cava in 63% of the patients; 48% presented with a post-phlebitic vein and/or an older thrombosis, and 46% had already had recurrent pulmonary emboli. Unsuccessful aggressive procedures had been carried out previously in 11%. The rate of intraoperative pulmonary embolism (PE) was 3% (one fatal case). The perioperative mortality was 6.8%, but only one death was related to the surgical treatment itself. During follow-up (8-140 months postoperatively, mean 55 +/- 34 months) late recurrent PE was confirmed in two patients (antithrombin III deficiency, contralateral DVT) and was reported as the suspected cause of death in a third (3.6%). Venous thrombectomy with arteriovenous fistula is a reliable and effective procedure for management of embolizing DVT and is indicated especially in young patients. The rates of early- and late-recurrent PE are low, introduction of artificial material into the vein can be avoided, and long-term preservation of valve function is occasionally possible.

Prothrombin and Factor V Mutations in Women with a History of Thrombosis during Pregnancy and the Puerperium

“…The details and results of this procedure have been reported elsewhere. [17][18][19][20] Among these 77 women, thrombectomy was performed in 39 (51 percent) during pregnancy and after delivery in 38 (49 percent).…”

The Mesenteric-Caval Fistula: First Results of a New Technique in a Transperitoneal Reconstruction of the Caval Vein by Fulminant Thrombosis of the Inferior Vena Cava Based on Homozygous Antithrombin III-Deficiency

“…For 47 patients (69 extremities, >1 year postoperative) 17.4% of their extremities gave no discomfort, 40.6% had a slight PTS, 30.4% moderate and 11.6% severe PTS (Ulcus ruris in 7.2%). The long-term opening rate was good, peripheral venous congestion complaints were not rare [11] [12].…”

“…There were reports of rare cases of a deep vein thrombosis in combination with a free-floating caval thrombus ascending up to the renal veins. In these cases arteriovenous fistulas could be placed on both groin blood vessels [11].…”

Unilateral Extremity Swelling in Female Patients with Cancer

“…Unfortunately, a 7% mortality perioperatively was observed, attributed usually to pulmonary migration of the thrombus. 6 Because of the overwhelming complications associated with thrombectomy, it has been largely abandoned as an option in the treatment of DVT. Surgical resection is employed today only in the rare case of massive thrombosis that does not respond to thrombolytic agents and may subsequently compromise the arterial circulation of the affected limb.…”