Prophylactic interruption of the inferior vena cava: immediate and long-term hemodynamic effects
S. M. Korwin, A. D. Callow, D. Rosenthal, B. Ledig, R. A. Deterling Jr and T. F. O'Donnell Jr
Two hundred patients were evaluated retrospectively to determine the
clinical effects of prophylactic inferior vena cava (IVC) interruption in
association with aortic reconstruction. No pulmonary embolism occurred in
the group with IVC interruption, but embolisms did occur in seven of 68
patients who had aortic reconstruction performed without IVC interruption.
In two patients, the pulmonary embolism was fatal. Postoperative incidence
of deep vein thrombosis was fatal. Postoperative incidence of deep vein
thrombosis was 9% in both groups. Clinical and hemodynamic effects of
prophylactic IVC interruption were studied in 20 additional patients.
Venous hemodynamics (maximum venous outflow, inferior vena cava pressure,
and ambulatory venous pressure) showed no change following interruption in
19/20. Sixteen patients from the original group of patients with
prophylactic interruption were studied hemodyamically. No pulmonary
embolism was clinically evident. One new case of deep vein thrombosis was
seen. Again, venous hemodynamics showed no change as a result of IVC
interruption. Prophylactic IVC interruption is a safe means of decreasing
the incidence of pulmonary embolism without increasing venous-related
morbidity.
