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Pulmonary Emboli Following Vena Caval Ligation

Pulmonary Emboli Following Vena Caval Ligation Abstract LIGATION of the inferior vena cava (IVC) has long been the procedure of choice for the treatment of large recurrent pulmonary emboli. Caval ligation has also been advocated for patients with cor pulmonale due to repeated showers of small emboli, for patients with septic emboli from pelvic suppurative disease, and prophylactically in certain selected patients. Studies have shown that approximately 75% to 90% of all pulmonary emboli can be expected to originate below the usual site of inferior vena caval ligation and thus are amenable to treatment by this procedure.1-5 At first thought, venous ligation above the source of the emboli seems to be a reasonable approach. However, blood from the legs and pelvis must return to the heart by some route and, following ligation, this is accomplished through collateral venous channels. Conceivably, vessels large enough to accomodate this amount of blood flow are also capable of carrying emboli References 1. Zeitlhofer, J., and Reiffenstuhl, G.: Untersuchungen über fulminante, tödliche Lungenembolien am Obudktionsmaterial der Jahre 1941 bis 1951 , Wein Klin Wchnschr 64:446-451 ( (June 20) ) 1952. 2. Crutcher, R.R., and Daniel, R.A.: Pulmonary Embolism: A Correlation of Clinical and Autopsy Studies , Surgery 23:47-62 ( (Jan) ) 1948. 3. Byrne, J.J., and O'Neill, E.E.: Fatal Pulmonary Emboli: A Study of 130 Autopsy Proven Fatal Cases , Amer J Surg 83:47-49 ( (Jan) ) 1952.Crossref 4. Crane, C.: Deep Venous Thrombosis and Pulmonary Embolism: Experience With 391 Patients Treated With Heparin and 126 Patients Treated by Venous Division, With a Review of the Literature , New Eng J Med 257:147-157 ( (July 25) ) 1957.Crossref 5. McLachlin, J., and Patterson, J.C.: Some Basic Observations on Venous Thrombosis and Pulmonary Embolism , Surg Gynec Obstet 93:1-8 ( (July) ) 1951. 6. Just-Viera, J.O.: Massive Pulmonary Embolism: II. Predictable Mortality and Cardiopulmonary Changes in Dogs Breathing Room Air , Arch Surg 159:636-644 ( (April) ) 1964. 7. Adams, J.T., and DeWeese, J.A.: Experimental and Clinical Evaluation of Partial Vein Interruption in the Prevention of Pulmonary Emboli , Surgery 57:82-102 ( (Jan) ) 1965. 8. Schauble, J.F.; Stickle, D.I.; and Anlyan, W.G.: Vena Cava Ligation for Thromboembolic Disease , Arch Surg 84:17-24 ( (Jan) ) 1962.Crossref 9. Dale, W.A.; Pualwan, F.; and Bauer, F.M.: Ligation of the Inferior Vena Cava With Absorbable Gut , Surg Gynec Obstet 102:517-530 ( (May) ) 1956. 10. Robinson, L.S.: The Collateral Circulation Following Ligation of the Inferior Vena Cava: Injection Studies in Stillborn Infants , Surgery 25:329-347 ( (March) ) 1949. 11. Filler, R.M., and Edwards, E.A.: Collaterals of the Lower Inferior Vena Cava in Man Revealed by Venography , Arch Surg 84:10-16 ( (Jan) ) 1962.Crossref 12. Ferris, E.J., et al: The Inferior Vena Cava After Ligation and Plication , Radiology 89:1-10 ( (July) ) 1967.Crossref 13. Goodwin, J.F.; Harrison, C.V.; and Wilcken, D.E.L.: Obliterative Pulmonary Hypertension and Thromboembolism , Brit Med J 1:701-711, 777-783 ( (March) ) 1963.Crossref 14. Edwards, E.A.; Dexter, L.; and Donahue, W.C.: Recurrent Pulmonary Embolism as a Remediable Cause of Heart Failure , Geriatrics 16:423-432 ( (Aug) ) 1961. 15. Castleman, B., and McNeely, B.U. (eds.): Case Records of the Massachusetts General Hospital , New Eng J Med 277:360-370 ( (Aug 17) ) 1967.Crossref 16. Cosgriff, S.W.; Cross, R.J.; and Habif, D.V.: The Management of Venous Thrombosis and Pulmonary Embolism , Surg Clin N Amer 28:324-340, 1948. 17. Schauble, J.F., et al: A Study of Recurrent Pulmonary Embolism , Arch Surg 80:105-111 ( (Jan) ) 1960.Crossref 18. Donaldson, G.A.; Linton, R.R.; and Rodkey, G.V.: A Twenty-Year Survey of Thromboembolism at the Massachusetts General Hospital, 1939-1959 , New Eng J Med 265:208-214 ( (Aug 3) ) 1961.Crossref 19. Mozes, M., et al: Vein Ligation in the Treatment of Pulmonary Embolism , Surgery 55:621-629 ( (May) ) 1964. 20. Ochsner, A.: Indications for and Results of Inferior Vena Caval Ligation for Thromboembolic Disease , Postgrad Med 27:193-196 ( (Feb) ) 1960. 21. Krause, R.J., et al: Caval Ligation in Thromboembolic Disease , Arch Surg 87:184-192 ( (July) ) 1963.Crossref 22. Crane, C.: Femoral vs Caval Interruption for Venous Thromboembolism , New Eng J Med 270: 819-822 ( (April 16) ) 1964.Crossref 23. Stevens, L.E., et al: Ligation of the Inferior Vena Cava , Arch Surg 90:578-585 ( (April) ) 1965.Crossref 24. Wheeler, C.G., et al: Interruption of the Inferior Vena Cava for Thromboembolism , Ann Surg 163:199-204 ( (Feb) ) 1966.Crossref 25. Zollinger, R., and Teachnor, W.H.: Late Results of Inferior Vena Caval Ligations , Arch Surg 65:31-36 ( (July) ) 1952.Crossref 26. Dale, W.A.: Inferior Vena Caval Ligation for Venous Thromboembolism , Rev Surg 19:1-14 ( (Jan) -Feb) 1962. 27. Nabseth, D.C., and Moran, J.M.: Reassessment of the Role of the Inferior-Vena-Cava Ligation in Venous Thromboembolism , New Eng J Med 273:1250-1253 ( (Dec 2) ) 1965.Crossref 28. Boyd, D.P.: Ligation of the Inferior Vena Cava: Report of Four Cases , Lahey Clin Bull 7:152-154 ( (July) ) 1951. 29. Crum, R.B.: Inferior Vena Caval Ligation for Thromboembolism , Surg Gynec Obstet 67:320-322 ( (Nov) -Dec) 1959. 30. Bergan, J.J., et al: Prevention of Pulmonary Embolism: Comparison of Vena Cava Ligation, Plication and Filter Operations , Arch Surg 92:605-610 ( (April) ) 1966.Crossref 31. Gurewich, V.; Thomas, D.P.; and Rabinov, K.R.: Pulmonary Embolism After Ligation of the Inferior Vena Cava , New Eng J Med 274:1350-1354 ( (June 16) ) 1966.Crossref 32. Burget, D.E., et al: Inferior Vena Cava Plication for Prevention of Pulmonary Embolism: Results in 24 Cases , Ann Surg 165:437-441 ( (March) ) 1967.Crossref 33. Just-Viera, J.O.; Aguila, R.P.D.; and Yeager, G.H.: Massive Pulmonary Embolism: VI. Prevention by Partial Occlusion of the Inferior Vena Cava , Surgery 59:1008-1018 ( (June) ) 1966. 34. Thomas, D.P.: Treatment of Pulmonary Embolic Disease: A Critical Review of Some Aspects of Current Therapy , New Eng J Med 273:885-892 ( (Oct 21) ) 1965.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1968 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1968.01340060077008
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Abstract

Abstract LIGATION of the inferior vena cava (IVC) has long been the procedure of choice for the treatment of large recurrent pulmonary emboli. Caval ligation has also been advocated for patients with cor pulmonale due to repeated showers of small emboli, for patients with septic emboli from pelvic suppurative disease, and prophylactically in certain selected patients. Studies have shown that approximately 75% to 90% of all pulmonary emboli can be expected to originate below the usual site of inferior vena caval ligation and thus are amenable to treatment by this procedure.1-5 At first thought, venous ligation above the source of the emboli seems to be a reasonable approach. However, blood from the legs and pelvis must return to the heart by some route and, following ligation, this is accomplished through collateral venous channels. Conceivably, vessels large enough to accomodate this amount of blood flow are also capable of carrying emboli References 1. Zeitlhofer, J., and Reiffenstuhl, G.: Untersuchungen über fulminante, tödliche Lungenembolien am Obudktionsmaterial der Jahre 1941 bis 1951 , Wein Klin Wchnschr 64:446-451 ( (June 20) ) 1952. 2. Crutcher, R.R., and Daniel, R.A.: Pulmonary Embolism: A Correlation of Clinical and Autopsy Studies , Surgery 23:47-62 ( (Jan) ) 1948. 3. Byrne, J.J., and O'Neill, E.E.: Fatal Pulmonary Emboli: A Study of 130 Autopsy Proven Fatal Cases , Amer J Surg 83:47-49 ( (Jan) ) 1952.Crossref 4. Crane, C.: Deep Venous Thrombosis and Pulmonary Embolism: Experience With 391 Patients Treated With Heparin and 126 Patients Treated by Venous Division, With a Review of the Literature , New Eng J Med 257:147-157 ( (July 25) ) 1957.Crossref 5. McLachlin, J., and Patterson, J.C.: Some Basic Observations on Venous Thrombosis and Pulmonary Embolism , Surg Gynec Obstet 93:1-8 ( (July) ) 1951. 6. Just-Viera, J.O.: Massive Pulmonary Embolism: II. Predictable Mortality and Cardiopulmonary Changes in Dogs Breathing Room Air , Arch Surg 159:636-644 ( (April) ) 1964. 7. Adams, J.T., and DeWeese, J.A.: Experimental and Clinical Evaluation of Partial Vein Interruption in the Prevention of Pulmonary Emboli , Surgery 57:82-102 ( (Jan) ) 1965. 8. Schauble, J.F.; Stickle, D.I.; and Anlyan, W.G.: Vena Cava Ligation for Thromboembolic Disease , Arch Surg 84:17-24 ( (Jan) ) 1962.Crossref 9. Dale, W.A.; Pualwan, F.; and Bauer, F.M.: Ligation of the Inferior Vena Cava With Absorbable Gut , Surg Gynec Obstet 102:517-530 ( (May) ) 1956. 10. Robinson, L.S.: The Collateral Circulation Following Ligation of the Inferior Vena Cava: Injection Studies in Stillborn Infants , Surgery 25:329-347 ( (March) ) 1949. 11. Filler, R.M., and Edwards, E.A.: Collaterals of the Lower Inferior Vena Cava in Man Revealed by Venography , Arch Surg 84:10-16 ( (Jan) ) 1962.Crossref 12. Ferris, E.J., et al: The Inferior Vena Cava After Ligation and Plication , Radiology 89:1-10 ( (July) ) 1967.Crossref 13. Goodwin, J.F.; Harrison, C.V.; and Wilcken, D.E.L.: Obliterative Pulmonary Hypertension and Thromboembolism , Brit Med J 1:701-711, 777-783 ( (March) ) 1963.Crossref 14. Edwards, E.A.; Dexter, L.; and Donahue, W.C.: Recurrent Pulmonary Embolism as a Remediable Cause of Heart Failure , Geriatrics 16:423-432 ( (Aug) ) 1961. 15. Castleman, B., and McNeely, B.U. (eds.): Case Records of the Massachusetts General Hospital , New Eng J Med 277:360-370 ( (Aug 17) ) 1967.Crossref 16. Cosgriff, S.W.; Cross, R.J.; and Habif, D.V.: The Management of Venous Thrombosis and Pulmonary Embolism , Surg Clin N Amer 28:324-340, 1948. 17. Schauble, J.F., et al: A Study of Recurrent Pulmonary Embolism , Arch Surg 80:105-111 ( (Jan) ) 1960.Crossref 18. Donaldson, G.A.; Linton, R.R.; and Rodkey, G.V.: A Twenty-Year Survey of Thromboembolism at the Massachusetts General Hospital, 1939-1959 , New Eng J Med 265:208-214 ( (Aug 3) ) 1961.Crossref 19. Mozes, M., et al: Vein Ligation in the Treatment of Pulmonary Embolism , Surgery 55:621-629 ( (May) ) 1964. 20. Ochsner, A.: Indications for and Results of Inferior Vena Caval Ligation for Thromboembolic Disease , Postgrad Med 27:193-196 ( (Feb) ) 1960. 21. Krause, R.J., et al: Caval Ligation in Thromboembolic Disease , Arch Surg 87:184-192 ( (July) ) 1963.Crossref 22. Crane, C.: Femoral vs Caval Interruption for Venous Thromboembolism , New Eng J Med 270: 819-822 ( (April 16) ) 1964.Crossref 23. Stevens, L.E., et al: Ligation of the Inferior Vena Cava , Arch Surg 90:578-585 ( (April) ) 1965.Crossref 24. Wheeler, C.G., et al: Interruption of the Inferior Vena Cava for Thromboembolism , Ann Surg 163:199-204 ( (Feb) ) 1966.Crossref 25. Zollinger, R., and Teachnor, W.H.: Late Results of Inferior Vena Caval Ligations , Arch Surg 65:31-36 ( (July) ) 1952.Crossref 26. Dale, W.A.: Inferior Vena Caval Ligation for Venous Thromboembolism , Rev Surg 19:1-14 ( (Jan) -Feb) 1962. 27. Nabseth, D.C., and Moran, J.M.: Reassessment of the Role of the Inferior-Vena-Cava Ligation in Venous Thromboembolism , New Eng J Med 273:1250-1253 ( (Dec 2) ) 1965.Crossref 28. Boyd, D.P.: Ligation of the Inferior Vena Cava: Report of Four Cases , Lahey Clin Bull 7:152-154 ( (July) ) 1951. 29. Crum, R.B.: Inferior Vena Caval Ligation for Thromboembolism , Surg Gynec Obstet 67:320-322 ( (Nov) -Dec) 1959. 30. Bergan, J.J., et al: Prevention of Pulmonary Embolism: Comparison of Vena Cava Ligation, Plication and Filter Operations , Arch Surg 92:605-610 ( (April) ) 1966.Crossref 31. Gurewich, V.; Thomas, D.P.; and Rabinov, K.R.: Pulmonary Embolism After Ligation of the Inferior Vena Cava , New Eng J Med 274:1350-1354 ( (June 16) ) 1966.Crossref 32. Burget, D.E., et al: Inferior Vena Cava Plication for Prevention of Pulmonary Embolism: Results in 24 Cases , Ann Surg 165:437-441 ( (March) ) 1967.Crossref 33. Just-Viera, J.O.; Aguila, R.P.D.; and Yeager, G.H.: Massive Pulmonary Embolism: VI. Prevention by Partial Occlusion of the Inferior Vena Cava , Surgery 59:1008-1018 ( (June) ) 1966. 34. Thomas, D.P.: Treatment of Pulmonary Embolic Disease: A Critical Review of Some Aspects of Current Therapy , New Eng J Med 273:885-892 ( (Oct 21) ) 1965.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1968

References