Surgical treatment of septic deep venous thrombosis.
BACKGROUND
Septic deep venous thrombosis (SDVT) is an uncommon but occasionally lethal disease caused by systemic complications. In most cases reported in the literature SDVT is caused by intravenous drug abuse or transvenous catheter lines. Conservative management with antibiotic drugs and systemic anticoagulation is usually successful, and the surgical approach is regarded as not indicated or unnecessary. Occasionally, however, conservative management fails, thrombosis progresses, and septic embolism develops.


METHODS
In a 7-year period five patients (three male and two female; mean age, 21.2 years), three with severe systemic complications of SDVT (femoropopliteal, 1; iliofemoral, 1; iliofemoral+vena cava, 3), were treated by venous thrombectomy in addition to intravenous antibiotic administration. Simultaneous transabdominal caval thrombectomy was performed twice.


RESULTS
Two patients suffered from respiratory failure caused by previous septic embolization. One patient had experienced multiorgan failure before thrombectomy was performed. Intensive care was necessary for all patients (mean, 28 days). All patients survived.


CONCLUSIONS
In complicated cases of SDVT without improvement or even impairment after conservative management, venous thrombectomy is a lifesaving treatment.
Kniemeyer
H W
HW
Department of Anesthesiology, Heinrich-Heine-University Düsseldorf, Germany.
Grabitz
K
K
Buhl
R
R
Wüst
H J
HJ
Sandmann
W
W
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013924:Thrombophlebitis / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D014656:Vascular Surgical Procedures
D000900:Anti-Bacterial Agents