Femoral Vein Ligation Research Articles

Thromboembolic Disease in Obstetrics and Gynecology: The Value of Early Diagnosis and Adequate Treatment

Summary In addition to reducing the incidence of fatal pulmonary emboli and chronic venous insufficiency the early and adequate treatment of thromboembolic disease greatly diminishes the hospital stay of these patients. It also shortens the duration of the disease and the period of bed rest. The average increase in hospital stay of 2.6 days in those patients treated early and adequately is 7.8 days less than the hospital stay of the patients treated adequately but late. The cost of this additional hospitalization is much more than that of the usual course of anticoagulant therapy; hence the expense of the anticoagulants should not be a consideration in initiating treatment. Also, with inadequate treatment, the patient's chances are greatly increased oi poor functioning of the leg, which results in a lifelong disability with its consequent expense and diminished earning power. The major etiological factors were summarized and, as emphasized in other reports, it is important to recognize the role played by heart disease, obesity, anemia, varicosities, hemorrhage', and morbidity. Aside from cesarean section, the type of delivery had little influence on the incidence oi thromboembolic disease. A few of the diagnostic features are discussed in detail. (Contrary lo other reports, an unusual number of these patients had femoral or pelvic thrombophlebitis at the onset. An explanation for this is that the trauma ul both operation and delivery in gynecology and obstetrics is centered on the pelvic veins and an increased incidence of thrombophlebitis in these vessels should be expected. An elevation in temperature was not always present at the onset or during the course of the disease despite other signs of active thrombophl ebitis. Pelvic thrombophlebitis is usually associated with pelvic infection and is rather difficult to diagnose. The lack of response to the antibiotics alone and the marked improvement which occurs when the anticoagulants are added is often the most conclusive diagnostic finding, although by careful pelvic examination the involved veins may sometimes be palpated. The response to treatment in the cases of pelvic thrombophlebitis was satisfactory and vena cava ligation was not necessary. However, the two cases of chronic venous insufficiency treated by deep femoral vein ligation were improved. The fundamentals of treatment with the anticoagulants, antibiotics, and the Trendelenburg position are well known. The accessory procedures such as paravertebral block and intravenous procaine have a definite place in therapy in selected cases. The time of ambulation has been difficult to decide but if it is begun when the anticoagulant level is within therapeutic range, the signs and symptoms are absent, and the temperature, has been normal for a 24 hour period, a minimum of complications will arise. Prenatal patients should receive heparin alone unless prolonged therapy is necessary', in which even I Dicumarol may be used with caution. Both heparin and Dicumarol may he begun immediately following delivery and operation when indicated. The complications due to anticoagulants were few in number and may lie kept at a minimum by careful clinical supervision. In general heparin causes fewer hemorrhagic complications than Dicumarol and these can he rapidly reversed with protamine sulfate and blood transfusion. The potential dangers of anticoagulant therapy must be remembered and the anticoagulants should be used only under careful clinical observation and laboratory control.

Spontaneous venous thrombosis in the legs of tall men.

A dangerous type of spontaneous venous thrombosis in the legs was seen in six men, during a two-year period. All of these men were over 6 ft. (182.88 cm.) tall, and four of them were 6 ft. 2 in. (187.96 cm.) or more. In none of these patients did the venous thromboses follow surgical operations, but in each case they appeared after severe physical strain or for no apparent reason. In all of the many other patients seen with thrombophlebitis over the same two-year period, the thromboses occurred either postoperatively or post-partum, or as a result of malignancy, prolonged illness, or involved superficial varicose veins. In three of the tall patients pulmonary infarction was the first symptom, and five required either iliac or femoral vein ligation. All six of these patients had, initially or eventually, bilateral involvement. Two of the patients had pulmonary emboli while receiving anticoagulants, and a third

Leg ulcers of vascular origin and their therapy

The ambulatory and hospital treatment of gravitational ulcers and the value of sulfonamides, antibiotics and sympathicolytic drugs are discussed. The following three types of bandages are described: the pressure, supportive and protective bandage. Their indications are enumerated. The results of a consequent carried out foam rubber compression therapy with the understanding cooperation of the patient are remarkable. Ligations of the saphenous and perforating veins and postoperative sclerotherapy have to be undertaken as causative approaches to the problem. The beneficial effect of ligation of the superficial femoral vein in postphlebitic states is not yet proven. The value of skin grafting and local surgery is appraised. In ulcers due to arterial disease elimination of vasospastic reflexes has to be achieved by interruption of sympathetic pathways either by injection or by operation. The value of etamon and priscoline® is discussed. The danger of sensitization by the topical use of drugs and antibiotics is also discussed. The usefulness of vitamins in the therapy of leg ulcers is not established. Prophylaxis is the most important factor in the therapy of peripheral vascular disease.

Stellate block as an adjunct to the treatment of pulmonary embolism.

MUCH interest has been evinced in recent years in the manifestations of thromboembolic disease. A voluminous literature has appeared concerning the use of anticoagulants and femoral-vein ligation. These measures, however, have been directed primarily toward preventing pulmonary embolism rather than at influencing the immediate effects of the emboli themselves, and little progress has been made in augmenting the meager list of measures that are of use in the treatment of the acute phase of the condition. The methods of immediate treatment can be divided into operative technics and all others, including the use of drugs, general supportive measures and minor . . .

Surgical management of femoral vein thrombosis

Homans' clinical forms of femoral vein thrombosis are reviewed. Indications for surgical intervention are given. Two approaches to the femoral vein are described and details of the operative procedure in thrombotic disease given. Femoral vein ligation for prophylactic purposes in the absence of embolism is debatable. Femoral vein exploration remains the treatment of choice once embolism has occurred and there is clinical evidence of thrombosis in the deep veins of the lower extremity.

Treatment of pulmonary embolism

1. 1. The etiology and present methods of treatment of pulmonary emboli are reviewed, emphasizing the fact that most emboli are believed to originate from free propagating thrombi in the femoral venous system. 2. 2. The use of femoral vein ligation in the prophylactic treatment of pulmonary embolism and the use of venography in the diagnosis and localization of femoral thrombi are discussed and evaluated. 3. 3. Five cases are reported in which accurate diagnosis of femoral vein thrombi was made largely through the use of venography and in which satisfactory results were obtained by ligating and partially resecting the involved femoral vein. Three of the patients had suffered pulmonary emboli before the femoral vein ligation was performed. 4. 4. In addition to the removal of danger of further pulmonary emboli, the operation of ligation and partial resection of the femoral vein was observed to have a beneficial effect on associated thrombophlebitis when this was present, particularly in the prevention as well as relief of associated peripheral edema.

Femoral vein ligation for chronic occlusive arterial disease: Glaser, S. Thomas, and Lesser, Albert: Am. J. Surg. 52: 100, 1941

Femoral vein ligation for chronic occlusive arterial disease: Glaser, S. Thomas, and Lesser, Albert: Am. J. Surg. 52: 100, 1941

Femoral vein ligation for chronic occlusive arterial disease: A study of twenty cases

Femoral vein ligation for chronic occlusive arterial disease: A study of twenty cases

Experience with Femoral-Vein Ligation for Prophylaxis of Postoperative Pulmonary Embolism

Experience with Femoral-Vein Ligation for Prophylaxis of Postoperative Pulmonary Embolism