Prophylactic Teflon Clip Plication of the Inferior Vena Cava for Prevention of Pulmonary Embolism*

Ha, McDowell

doi:10.1097/00007611-197303000-00019

Cited by 3 publications

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“…Although several authors have suggested the appropriateness of prophylactic plication of the IVC in patients at relatively high risk [14][15][16][17], particularly if they are undergoing abdominal or pelvic surgery, there are no well-controlled, prospective, randomized trials supporting this approach. Certainly, the frequent and occasionally serious post-plication sequelae argue effectively against any decision to perform caval plication prophylactically, particularly when nonoperative prophylactic techniques of high proven efficacy that involve less risk are currently available.…”

Section: Ileofemoral Venous Thrombosis With Proven Pulmonary Embolism...mentioning

confidence: 99%

The role of operative inferior vena caval interruption in the management of venous thromboembolism

Bernstein

1978

World J. Surg.

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Inferior vena caval interruption by direct operative techniques remains the mainstay of therapy for those patients with pulmonary embolism who cannot be treated effectively by anticoagulation, or who sustain recurrent embolic episodes despite adequate anticoagulation therapy. Complete ligation of the cava is associated with a somewhat higher operative mortality than plication, but appears indicated for those situations in which even a small subsequent embolus would be life‐threatening. Plication, which has more frequent indications, is generally performed by placement of an external clip, with an acceptable operative mortality and effective control of recurrent emboli. Longterm caval patency following plication approximates 70%, and should minimize late sequelae, which appear most closely related to the extent of preexisting venous thrombotic disease. Technical aspects of the performance of caval interruption procedures are critical in insuring success and minimizing late recurrences and complications. The direct operative approaches permit precise anatomic location of the caval interruption and simultaneous ligation of associated major venous collaterals, which is an effective, low‐risk approach to the life‐threatening pulmonary embolism problem.

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Section: Ileofemoral Venous Thrombosis With Proven Pulmonary Embolism...mentioning

confidence: 99%

The role of operative inferior vena caval interruption in the management of venous thromboembolism

Bernstein

1978

World J. Surg.

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Extended indications for placement of an inferior vena cava filter

Rohrer

Scheidler

Wheeler

et al. 1989

Journal of Vascular Surgery

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To study the morbidity and mortality rates after placement of an inferior vena cava filter and to define the appropriate indications for interruption of the inferior vena cava, the records of all patients who underwent insertion of a Greenfield filter during the decade January 1978 to December 1987 were reviewed. Patients were designated as having either a traditional or extended indication for placement of an inferior vena cava filter. Two hundred sixty inferior vena cava filters were placed in 264 attempts, with no deaths related to insertion of the filter. An extended indication was the primary reason for placement of the Greenfield filter in 66 (25%) of the patients. In patients with extended indications there were no cases of air embolism or filter misplacement and only three wound complications (4.5%). Pulmonary embolism after insertion of the inferior vena cava filter occurred in three patients (4.5%), with one fatality (1.5%). Inferior vena cava occlusion was documented in three cases (4.5%), and manifestations of the postphlebitic syndrome in early follow-up were present in two patients (3.0%). As the procedures to prevent fatal pulmonary embolism have become safer, more efficacious, and less morbid, the number of patients in whom the potential benefits of insertion of an inferior vena cava filter outweigh the risks has become larger. Our results support the liberalized use of Greenfield filters in those patients who do not necessarily have one of the traditional indications for placement of an inferior vena cava filter but are at a high risk of having a fatal pulmonary embolus.

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Prophylactic Interruption of the Inferior Vena Cava: Immediate and Long-Term Results

et al. 1992

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To determine the effects of prophylactic interruption of the inferior vena cava (IVC) the hospital course of 340 patients who underwent aortic operations with placement of a Moretz IVC clip between 1980 and 1988 was removed: 175 patients had had abdominal aortic aneurysm resection; 143, aortobifemoral by pass; and 22, aortobiiliac endarterectomy or bypass. There were no complica tions related to placement of the IVC clip. After operation, any clinical suspicion of deep vein thrombosis (DVT) or pulmonary embolus (PE) was docu mented by phlebography or pulmonary arteriography, respectively. In the im mediate postoperative period ( < thirty days), only 2 (0.5%) patients had a PE and 10 (2.9%) a DVT. For long-term follow-up extending to eight years (mean ± 42.8 months), 308 patients were available. During long-term follow-up, 2 (0.6%) patients had a PE and 7 (2.2%) a DVT. Limb edema without evidence of DVT occurred in another 7 (2.2%) patients. B-mode ultrasonography of the IVC was performed in 163 patients. The IVC was clearly patent in all but 5 (3%): 1 had had a documented PE in the immediate postoperative period, and the other 4, an asymptomatic occlusion of the IVC during late follow-up. Prophylactic IVC interruption in aortic surgical patients appears not to cause IVC thrombosis, to initiate DVT, or to cause chronic venous insufficiency. The results indicate that it is a safe method of decreasing the incidence of PE, without increasing operative morbidity.

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Prophylactic Teflon Clip Plication of the Inferior Vena Cava for Prevention of Pulmonary Embolism*

Cited by 3 publications

References 0 publications

The role of operative inferior vena caval interruption in the management of venous thromboembolism

The role of operative inferior vena caval interruption in the management of venous thromboembolism

Extended indications for placement of an inferior vena cava filter

Prophylactic Interruption of the Inferior Vena Cava: Immediate and Long-Term Results

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