Reevaluation of surgical therapy in acute deep venous thrombosis of the lower limbs.
Surgical treatment of phlebothrombosis is not uniformly accepted. The presented results in a series of 53 patients, show nevertheless that thrombectomy and valvular destruction are no longer synonyms. Adequate "vein-respecting" technique - and severe patient selection guarantee better results than thrombolytic or heparin therapy as well in relation to patency as valvular function. Surgical therapy consists of a venous thrombectomy and a distal arterio-venous fistula. The importance of the ultra-doppler-sonography (UDS) in pre- and postoperative examinations is stressed. Forty-seven of the 53 patients had a complete repermeabilization of the venous system (90 %). Forty-four patients with complete repermeabilization could be followed-up for 1 to 3 1/2 years. Ninety-four per cent (42 patients) have an adequate valvular function reflected in a good clinical result. All normalized UDS-curves of the early postoperative period remained unchanged at repetitive postoperative controls up to 3 1/2 years and guaranteed a good clinical results. Phlebographic resolution of the thrombi doesn't mean a restored venous function, the post-thrombotic syndrome can only be avoided in case of competent venous valvular function. Any treatment of acute deep phlebothrombosis should therefore be evaluated functionally by UDS rather than by phlebography.
D000208:Acute Disease; D001314:Auscultation / Q000295:instrumentation; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D013924:Thrombophlebitis / Q000175:diagnosis / Q000601:surgery*; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000379:methods