Interruption of common femoral vein with thrombectomy

Interruption of common femoral vein with thrombectomy
  • Interruption of the common femoral vein is indicated when a thrombus is found in it, or if a patient has had a minor pulmonary embolus, irrespective of whether there are signs of venous thrombosis in the lower extremities. This level is chosen in order to perform the venous interruption proximal to the profunda femoris vein. The procedure should be performed in both extremities; it is recom­mended if a patient is seen within 48 to 72 hours after the onset of tenderness in the groin and edema of the extremity. The presence of a thrombus is readily de­tected by gentle palpation of the common femoral vein over a small right angle clamp passed behind it. Loose ligatures are placed around it, the distal one just proximal to the profunda femoris vein (1). The proximal one is placed proximal to the lateral circumflex vein (2), which should be ligated and divided, and distal to the medial circumflex vein (3). The rule is that there must be sufficient common femoral vein between the two ligatures so that later in the procedure it can be safely divided and both ends securely ligated. The proximal ligature should also be just distal to a tributary so that blood will continue to flow through the proximal end of the vein, in this case the medial circumflex vein. The long saphenous vein is not interrupted unless it is also thrombosed, in which case it is at the saphenofe – moral junction. A transverse incision is made midway between the ligatures. A dark fresh thrombus can be seen being extruded through it.
  • This shows the thrombectomy being performed by strong suction through a glass drinking tube. The glass permits the surgeon to see the thrombus being sucked out and avoid the necessity of pushing the tube up the vein, which might loosen the thrombus and cause a pulmonary embolus. If the patient is operated on early, the thrombus comes out with surprising ease and is followed by a gush of venous blood, indicating that the proximal vein has been cleared of blood clots. If it is impossible to get adequate back bleeding and the patient has had a minor pulmonary embolus, inferior vena cava interruption should be performed im­mediately. The distal thrombus can usually be partially aspirated and more of it expressed out by pressure on the thigh.
  • Another effective way of removing the proximal thrombus is with a large, venous-type Fogarty catheter. This is readily passed up through the thrombus. If the thrombus is recent and nonadherent, it is brought out with ease. It is im­portant to have the body of the patient elevated during this procedure also, so that the blood in the iliac and femoral veins is under positive pressure and will flush out small thrombi through the venotomy. Distal passage of the catheter has been recommended, but this probably results in damage to the venous valves, so its use in this manner is questionable.
  • Some surgeons prefer to maintain the venous continuity after thrombectomy by closure of the venotomy. However, since attacks may recur and because permanent interruption of the common femoral vein does not result in irrepar­able damage to an extremity, and furthermore since the postthrombotic syndrome develops because the femoral vein recanalizes, it seems justifiable to interrupt the common femoral vein by ligation and division. As shown, the vein is divided completely and both ends controlled with a ligature and transfixion suture of linen or cotton. One of the lateral branches of the vein had to be ligated to give suf­ficient length of vein to safely ligate and divide. The venous blood from the extremity returns through the profunda femoris and long saphenous veins as shown by the arrows. The incision is closed meticulously in layers.


Interruption of common femoral vein with thrombectomy



One comment

  1. Salomon Botas

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