Comparison of surgical managements for pulmonary emboli.

The high incidence of pulmonary embolism is well documented. At first suspicion of an embolism attack, adequate anticoagulant therapy was administered to 86% of the patients in this study. With failure of anticoagulants preoperatively, 30 patients received partial interruption of the IVC, 26 patients had their IVC ligated. Postoperatively, anticoagulants were administered to 64% of the patients who subsequently suffered recurrent attacks of embolism or new episodes of acute thrombophlebitis. These patients also had a substantial hazard of hemorrhage since 48% of the patients on heparin required transfusion. Postoperative mortality for the ligation group was associated with underlying conditions of the patients. These patients subjected to IVC plication had more deaths due to recurrence of pulmonary emboli and were demonstrated to have a substantially higher recurrence rate of pulmonary embolus. Reasons for this recurrence in both groups are discussed. Severe leg sequlae problems often associated with ligation were not encountered but were present in several patients subjected to plication.