Palma-Dale Operation for Chronic Ilio-femoral Vein Thrombosis

ABSTRACT

PURPOSE: Deep vein thrombosis is usually managed conservatively or with radiologic intervention. Yet deep vein reconstruction is of value as one of the treatments for a small group of patients who present with significant chronic venous insufficiency due to hypoplastic, absent or occluded deep venous outflow such as occurs because of chronic ilio-femoral vein thrombosis. Therefore, we evaluate the improvement of symptoms and graft patency after a Palma-Dale operation as a treatment modality for chronic ilio-femoral vein thrombosis. METHODS: From January 2001 to August 2008, a retrospective study was performed on 15 patients with chronic ilio-femoral vein thrombosis that was treated with a Palma-Dale operation. RESULTS: The mean age of the patients was 51.1+/-15.9 years. The ratio of males to females was 8 to 7. All the patients had lower limb swelling. A Palma-Dale operation was performed on all the patients. Simultaneous thrombectomy was done for 1 patient and arteriovenous fistulas were used to improve graft patency in four patients. The mean follow-up period was 36.3+/-24.0 months. Postoperatively, there was improvement of symptoms in all the patients. However, there was recurrence of symptoms in three patients after two or three months. The rate of graft patency was 84.1% at one year after surgery. CONCLUSION: The Palma-Dale operation has the possibility of recurrence of deep vein thrombosis and postoperative complications. Yet in patients with significant chronic venous insufficiency due to chronic ilio-femoral vein thrombosis, this type of surgery is obviously of value with respect to improvement of symptoms and an acceptable graft patency rate.