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

Abstract

AbstractInferior 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.