Surgery of the venous system - present state of the art.

The current status of surgery of the inferior vena cava, and the iliac and femoral veins in cases of phlebothrombosis, of postthrombotic syndrome, and in traumatic lesions is discussed. Each intervention in the venous system requires an exact preoperative diagnosis including phlebography and phlebodynamometry. After a mean observation period of 26 months, 41.4% excellent results were obtained following venous thrombectomy in cases of phlebothrombosis. Vena cava blockade as a prophylactic measure against pulmonary embolism is an accepted procedure now. It remains, however, limited to a few exceptional situations. Venous injuries proximal to the elbow and the knee can be successfully treated by direct suture or graft implantation with good functional results, whereas ligature of large veins causes postthrombotic syndrome of the limbs in over 50% of the cases. Chronic occlusion of iliac veins and postthrombotic syndrome may be treated by reconstructive methods, with the aid of a temporary arterio-venous fistula. The prerequisites of patent run-in and run-off reduce the number of operations to but a few cases.