Inferior Vena Caval Ligation

PULMONARY embolism, which is usually a complication of venous thrombosis in the lower limbs, is responsible for approximately 3 per cent. of howpital deaths. It is a common cause of morbidity and mortality in various medical and surgical conditions. It is generally accepted that anticoagulant therapy has an important place as a prophylactic measure in venous thrombosis and, when efficient, reduces the risk of pulmonary embolism by 80-95 per cent. The following case demonstrates that anticoagulant therapy may not be sufficient to prevent episodes of pulmonary embolism and would indicate that inferior caval ligation may be a life-saving procedure in selected cases. CASE REPORT. The patient was a man aged 51. Six weeks before admission to hospital he developed thrombophlebitis of the right leg and the following day he had an attack of left-sided chest pain which persisted for four days. He had two further episodes of chest pain and a frank haxmoptysis on the day preceding admission. On admission he was moderately distressed with chest pain and dyspncea. The blood pressure was 90/60 mm. Hg., the pulse was 96 per minute, the temperature 99.60 F., and the jugular venous pressure normal. He had signs of consolidation of the right lower lobe. There was evidence of thrombophlebitis of the right leg. A chest radiograph showed patchy consolidation at the right base. The electro-cardiogram showed sinus rhythm, a P-R interval of 0.16 sec. The P waves were of normal amplitude, ST segments iscelectric, T waves of low amplitude in V.5 and V.6, and axis deviation of +10°. There was no evidence of acute right ventricular embarrassment. He was treated with intravenous heparin and phenylindanedione ("dindevan"). The prothrombin activity level was maintained between 7 and 15 per cent. of normal. Six weeks later he sustained a further attack of severe chest pain, shock, dyspncea, and hxmoptysis. As anticoagulant therapy had failed to prevent a further episode of pulmonary embolism, it was decided to recommend ligation of the inferior vena cava. Anticoagulant therapy was discontinued on the day of operation and was not recommenced subsequently. The post-operative course was uneventful. He was allowed up after one week and was discharged from hospital at the end of three weeks. Four months after operation he is very well. There is slight dilatation of the superficial veins on the dorsum of the feet and minimal pitting cedema over the ankles. This is not severe enough to …