[Early and late results of transperitoneal thrombectomy in thrombosis of the inferior vena cava].

Acute inferior vena cava thrombosis is a rare clinical feature with unknown incidence. A clear evidence about the best treatment does not exist. Especially the indications for surgical therapy and their clinical results are published only in a few reports. So the aim of this study was to take a look to our experience and make an evaluation of the combined transcaval and transfemoral venous thrombectomy. In a retrospective study of the past 12 years 19 patients with a mean age of 28.5 years, 15 women and 4 men, showing ascension of a iliofemoral clot to the vena cava were treated by transperitoneal and transfemoral thrombectomy. The mean thrombus age was 7 days, 2 patients had bilateral iliofemoral thrombosis. Simultaneously a transfemoral thrombectomy and transcaval thrombectomy were performed after exposure of the vena cava inferior via transabdominal approach. In all cases a venous patency could be achieved, 3 times a re-thrombectomy within 1 week was necessary. One intraabdominal hematoma was revised surgically. One patient died on the first postoperative day because of a fulminant lung embolism. After a mean follow-up of 6 years 3 patients did not have any symptoms of post-thrombotic sequelae, 13 had mild and only one patient moderate post-thrombotic syndrome. The combined transperitoneal and transfemoral venous thrombectomy of the vena cava inferior represents a safe and effective treatment of the acute thrombosis of the vena cava inferior. Severe post-thrombotic sequelae especially in young women may be avoided.