Journal «Angiology and Vascular Surgery» • 

1997 • VOLUME 3 • №1


Dainis K. Krievins, M.D., Ramin E. Beygui, M.D., Gundars J.Katlaps, M.D., Thomas J. Fogarty, M.D.
Division of Vascular Surgery, Stanford University,
Stanford, USA

Estimates of the yearly incidence of the deep venous thrombosis (DVT) in the United States range from 8 to 20 million cases, combining a considerable social and economic problem. Major occlusion of veins as the cause of gangrene was first described by Fabricus Hildanus in 1593. Postpartum iliofemo-ral thrombophlebitis was first mentioned in the medical literature by Mauriceau 300 years ago. In 1949 De Bakey and Ochsner found 56 cases in the literature and reported 2 cases of their own experience of DVT. Anticoagulation has been the standard therapy for iliofemoral DVT for a long time, and still forms the "minimum standard therapy" for deep venous thrombosis at any site. Systemic thrombolythic therapy with purified streptokinase, urokinase and tissue plasminogen acti-vator (t-PA) to treat DVTs has been used for more than 20 years with equivocal success. The advent of catheter directed thrombolysis has improved the results and safety of thrombolytic therapy in a selected group of patients, albeit, at significant cost and prolonged period of treatment. Mahorner first introduced the concept of iliofemoral thrombectomy in the United States in 1954. The introduction of Fogarty balloon catheter for arterial thrombectomy was followed by the technique of catheter-based venous thrombectomy for iliofemoral DVT. The initial reports expressed much enthusiasm about the efficacy of venous thrombectomy. However, since De Weese's review in 1978 on iliofemoral vein thrombectomy and later reports of high failure rates of surgery, re thrombosis, and postphlebitic syndrome, the popularity of venous thrombectomy has been dampened in the US. In spite of subsequent favorable reports by Edward, Mavor, Ekiofand others, the popularity of venous thrombectomy in the United States has not been restored. Venous thrombectomy continued to develop in Europe and new approaches, such as the use of a temporary arterio-venous fistula (AVF) in conjunction with venous thrombectomy improved the results, and generated interest in surgical management of DVT. The review of recent reports point to significant advantages in removal of the thrombus to prevent long-term sequelae of DVT. It has became evident that in certain group of patients surgical thrombectomy is a safe, cost-effective and efficacious method of clot removal when compared to thrombolytic therapy or long-term anticoagulation.

P. 83

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