Ligation of the superficial femoral vein in prevention of pulmonary embolism: an old fashion procedure?

From 1974 to 1988, interruption of the superficial femoral vein (SFV) was performed to prevent pulmonary embolism (PE) in 73 patients. The mean age of the patients was 62 years. Phlebography showed thrombi in the following localizations: calf veins (67.3%), superficial femoral or popliteal veins (56.6%), common femoral veins (19.5%) and iliac veins (2.7%). A floating thrombus in the popliteal or femoral vein was the main indication for surgery in 97.3% of patients. Pulmonary embolism had occurred in 76.7% and was associated with neoplasm in 13.7%. Ligation of the SFV was performed in 93 limbs and completed iliac or femoral thrombectomy in 32.3%. The procedure was performed under locoregional anesthesia in 82.9% of the cases. Hospital mortality was 1.4% and 3 year survival, considering only PE related deaths was 95.3 +/- 2.7%. Follow-up was complete for all patients and averaged 3.0 years, for a 3 years PE-free rate of 90.8 +/- 3.6%. Persistent symptoms included increased limb tenseness in 12.5% and mild ankle edema in 25%. Bilateral strain-gauge plethysmography (SGP) was obtained in 65 limbs. The time necessary to obtain a 50, 75 and 100% decrease in calf volume (respectively T1/2, T3/4 and TT) was calculated for the operated limb and compared with the untreated limbs used as controls. A prolongation of T1/2 from 2.5 +/- 0.3 sec in controls to 4.3 +/- 0.4 sec in the operated limb (p less than 0.01) was found. Thus, our experience with ligation of the superficial femoral vein is favourable since long-term ill effects have been minimal and strain gauge plethysmography (SGP) showed only mildly altered venous drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined colonic and biliary surgery: assessment of risk in elderly patients.

From 1982 to 1986, routine preoperative ultrasound examination of the gallbladder and the liver was performed in all patients undergoing colonic surgery. A decision was made to do a cholecystectomy and intraoperative cholangiography when gallstones were found preoperatively. According to this prospective protocol, 20 patients had biliary surgery performed in conjunction with colonic resection. The mean age of these patients was 70 years (median, 70 years; range, 53-83 years). There was no death in this study group and only three nonfatal complications. Despite the fact that our operative strategy increases the average duration of the operation, it avoids the risk of postoperative cholecystitis and the possible need for a second operation in these elderly patients.