Surgery in acute and chronic venous disease.

This report describes a favorable experience with 140 cases of surgical intervention in deep venous disease of the lower extremity, divided between acute and chronic problems. Of these, 107 were treated for acute phlebitis and 33 for deep venous insufficiency. Seventy-seven cases of acute iliofemoral phlebitis underwent thrombectomy. Preoperative venography was done in all, and postoperative venography was done in 57 patients. Of these, 75% had patent iliofemoral segments after a modified surgical approach. A positive correlation has been found between the degree of adherence of the iliofemoral clot and the postoperative patency rate--and this usually can be predicted from the preoperative venographic findings. Clinical follow-up averages 4 years and extends to 11 years. Ligation and division of the superficial femoral vein was done as the sole procedure in 30 patients with acute deep venous thrombosis (DVT) and in five with deep vein insufficiency. Its indications were guided by preoperative venography. It has been successful as a means to control emboli in selected cases. Long-term ill-effects have been minimal. In chronic severe venous insufficiency, expanded applications for surgery are presented. Ligation of incompetent veins, reconstruction of valves, and anastomosis of major segments of the femoral system are presented with preoperative and postoperative studies. Postoperative thrombosis has not been a problem. Specific procedures are presented to remedy chronic problems of the deep venous system.