Thirty-year experience with surgical interruption of the inferior vena cava for prevention of pulmonary embolism.

Case records of 237 patients treated by inferior vena cava (IVC) ligation (154), suture plication (27) or clip application (56) were reviewed. Indications for surgery included failure of anticoagulation or femoral vein ligation to control embolism and threat of potentially massive, septic or paradoxical emboli. Overall hospital mortality was 15% and recent operative mortality was 2%. The incidence of early postoperative leg swelling was 36% and late venous sequellae occurred in 50% of the follow-up group of 140 cases followed an average of 44.3 months. Morbidity secondary to IVC interruption was decreased by use of the prosthetic lip, but clip application was still associated with early leg swelling in 21% and late mild swelling in 24%. The incidence of proven or suspected recurrent emboli was 7.6% with no significant variation by type of IVC procedure, and recurrent emboli were fatal in 2.5%. Refinement of indications, operative methods and perioperative care for IVC interruption procedures over the years has substantially improved the surgical approach to prevention of life-threatening pulmonary embolism.