Emergency interruption of the inferior vena cava: a debatable issue.

In spite of improvements in the diagnosis and treatment of thromboembolic disease, pulmonary embolism continues to be a major cause of morbidity and mortality. Anticoagulation remains the preferred therapy for deep venous thrombosis; however, this form of treatment is either ineffective or contraindicated for some patients. For these patients, partial interruption of the inferior vena cava via percutaneous filter placement has become the procedure of choice to protect against fatal pulmonary embolism. We described in this paper results obtained with the available permanent filters and complications of these filters described in the literature. We highlighted the interest of temporary filters in patients whose thromboembolic risk is temporary, finally we insist on recognised indications for vena cava filters when anticoagulation is contraindicated or ineffective.

Preoperative intraarterial thrombolysis before surgical revascularization for popliteal artery aneurysm with acute ischemia.

Because a popliteal artery aneurysm (PAA) generates emboli that progressively deteriorate the distal arterial network, they can constitute limb-threatening lesions. In 20 to 40% of cases, discovery of PAA coincides with sudden occlusion and resulting acute ischemia. In 40 to 60% of these patients, surgical revascularization fails and amputation is required. The objective of this prospective study was to assess the value of intraarterial thrombolysis to restore distal runoff before surgical revascularization. Between January 1, 1992 and December 31, 1996, we treated 15 PAA causing acute ischemia in 15 male patients with a mean age of 66.7 years (range, 44 to 87 years). Diagnosis was documented by clinical examination and ultrasound imaging. Intraarterial thrombolysis was performed under arteriographic control through a multiperforated catheter inserted by the anterograde femoral route to the thrombus. After an initial bolus of 100,000 U of urokinase, 600,000 to 1,600,000 U was continuously infused over a period of 6 to 18 hr. Heparin sodium was administered throughout thrombolysis. Surgical revascularization was performed within 1 to 4 days (mean, 2 days) after thrombolysis by exclusion and bypass in 14 cases and percutaneous transluminal angioplasty with stenting in 1 case. The ensuing results showed that, if performed carefully, intraarterial thrombolysis can safely prepare patients presenting with occluded PAA with acute ischemia for surgical revascularization to restore distal runoff. We use this combined technique routinely in our department. Morbidity is low in comparison with the risks of amputation.