Thromboembolic disease – Proximal superficial femoral vein interruption

Thromboembolic disease – Proximal superficial femoral vein interruption
        • The femoral artery must be treated with great care to prevent injury to it. Under no conditions should it be retracted with a rubber tube or catheter around it because of the danger of fracturing its wall, with resulting thrombosis and occlusion. (See Introduction, Plate 12 A.) Instead, it is best retracted by grasping its adventitia to dissect it free from the femoral vein with scissors. This may cause it to go into spasm, but it will not become thrombosed and occluded if treated in this manner. Two ligatures of linen or cotton are passed around the proximal end of the superficial femoral vein approximately a centimeter apart. These are held loosely while a transverse incision is made in the vein between them. Bleeding usually occurs from both the proximal and distal ends if there is no thrombus present. Sometimes the bleeding from the distal end is not very vigorous because of a more distal thrombus that cannot be seen.
        • The bleeding is readily controlled by grasping the edge of the venotomy with a hemostat as shown, then twisting the instrument about 360 degrees, which gives immediate control of the bleeding.
        • The proximal and distal edges of the venotomy are both grasped with hemo – stats for better control of the vessel. It is important to make sure there is active bleeding, especially from the proximal end, to rule out a thrombus in the common femoral vein. This is ascertained by twisting the hemostat on the distal venotomy cuff to control the bleeding from this end, or by tightening the previously placed distal ligature. If the back flow from the proximal end is sluggish, it may be because of a proximal thrombus that should be removed. If this is found, the com­mon femoral vein should be interrupted proximal to the profunda femoris branch after removing any thrombi in it. In most cases gentle palpation of the common femoral vein will help to determine the presence of a thrombus in this location before making the venotomy in the superficial femoral vein. If this is made and the common femoral vein needs to be interrupted in addition, the superficial femoral vein can likewise be interrupted without serious consequences, or the venotomy may be closed with a fine arterial suture.
        • Double ligation with division of the superficial femoral vein is recommended. This is accomplished most readily by placing two hemostats across the superficial femoral vein on either side of the venotomy.
        • The vein is then divided between them and each end is secured with a prox­imal ligature and a distal transfixion ligature of linen or cotton. The profunda femoris and saphenous veins are the main outflow vessels of the extremity. The incision is closed meticulously in layers with fine interrupted sutures of linen or cotton to prevent wound hematomas, which tend to interfere with lymph flow and cause lymphedema of the extremity. Great care is taken not to catch the branch of the femoral nerve, shown on the femoral artery in A, in one of the sutures; the nerve may also be found adherent to Scarpa’s fascia, and catching it may result in severe neuralgia. The skin is closed with interrupted vertical mattress sutures of silk. Unless the patient needs to remain in bed for other reasons, he should be ambulatory the following day, a definite advantage of this form of therapy. It is recommended also that postoperative anticoagulation with Coumadin be carried out while the patient is still hospitalized and then discontinued. For control of lymphedema an elastic stocking to the knee, or two elastic 4-inch Ace bandages, are used during the day but removed at night.

Thromboembolic disease - Proximal superficial femoral vein interruption

One comment


  1. Timothy - tnx for info.

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