Thrombectomy for acute deep vein thrombosis: prevention of postthrombotic syndrome.

Ninety-six limbs of 89 patients with acute deep vein thrombosis of the lower extremity were followed for 1 to 18 years. In the thrombectomy group (43 limbs), the cumulative incidence of pigmentation at the 15th year was 15%, but no stasis ulcers occurred throughout the follow-up period. In the conservative treatment group (53 limbs), the cumulative incidence of pigmentation at the 15th year was 41%, and that of stasis ulceration was 27%. Fogarty thrombectomy restricted below the pelvic vein spur and removal of thrombi in the leg veins by manual milking is sufficient to relieve early morbidity, preserve venous valve function, and promote intrapelvic collateral circulation. Preservation of venous valves in the femoropopliteal region is a key to the prevention of postthrombotic syndrome. Thrombectomy within 5 days of the onset of symptoms is recommended for patients with iliofemoropopliteal venous thrombosis.