The mode of production of iliofemoral thrombophlebitis

The mode of production of iliofemoral thrombophlebitis
  • Fortunately not all silent deep venous thrombi in the popliteal and femoral veins lodge in the pulmonary artery when they break off from their distal attach­ment; some lodge in the common femoral vein. It is significant that some patients have been known to complain of pain in the calf without much attention being paid to this complaint. Others may have had an unexplained concomitant rise in tem­perature, pulse and respirations, a complication not infrequently caused by deep venous thrombosis of one of the lower extremities and a minor pulmonary embolus.
  • Suddenly the patient experiences severe pain in the thigh. The leg often becomes pale in color and later cyanotic; the entire extremity to the groin becomes swollen in a matter of hours. It is believed that the long venous thrombus becomes impinged in the common femoral vein because in some patients the lumen of this vessel is uneven in outline, tending to entrap the thrombus at this site. Proximal thrombosis quickly develops to involve the external iliac vein, so that the outflow tract is markedly occluded. Temporarily at least, massive pulmo­nary embolism does not occur, but may develop from proximal propagating thrombi. In some patients after 72 hours a sterile inflammatory reaction develops between the thrombus and the venous endothelium, which causes it to become adherent in the iliofemoral region and results in the condition termed “occlusive thrombophlebitis.”
  • The above sequence of events should not occur if early surgical intervention by phlebotomy and thrombectomy is performed as soon as the diagnosis of an ob­structing thrombus in the femoral vein is made. Phlebography may be resorted to, but too often it may produce more thrombosis from the irritating effect of the radiopaque dye. From experience it has been observed that if the thrombus has been lodged in the femoral vein for less than 72 hours it can be extracted readily through a venotomy, similarly to an arterial embolus through an arteriotomy. The venous intima will still be smooth and shiny without adherent blood clot. Some surgeons favor closure of the venotomy to restore the continuity of the common femoral vein. It is my opinion, however, that interruption of it, as shown in this illustration, is preferable. Not only does this give immediate protection from a massive pulmonary embolus, but it also is the best insurance against emboli should phlebitis recur in the extremity. It also has the advantage that it helps to prevent the sequelae of the thrombotic state seen so commonly in the postthrom – botic limb with the uninterrupted femoral vein.

The mode of production of iliofemoral thrombophlebitis


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