Journal of vascular surgery
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Comparative Study
Phlegmasia complicating prophylactic percutaneous inferior vena caval interruption: a word of caution.
The purpose of this study was to evaluate the incidence of thrombotic complications in patients with deep vein thrombosis (DVT) who were treated with percutaneous inferior vena caval interruption in place of anticoagulation. ⋯ Percutaneous inferior vena caval interruption effectively prevents pulmonary embolism in patients with DVT but does not impact the underlying thrombotic process and in fact may contribute to progressive thrombosis in patients who are not given anticoagulants. Anticoagulation with intravenous heparin in safe and effective therapy for DVT in most patients. We believe that percutaneous insertion of vena cava filters should not replace anticoagulation in routine proximal DVT, and those patients who require an inferior vena cava filter for failure of anticoagulation should continue to receive heparin to treat the primary thrombotic process. We caution that relative contraindications to anticoagulation should be carefully scrutinized before recommending vena cava interruption as a primary therapy for DVT.
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Aortocaval fistulas are a rare complication of spontaneous rupture of an abdominal aortic aneurysm, representing an incidence of 2% and 4%. A review of the literature revealed 159 reported cases of aortocaval fistulas. ⋯ Primary closure of the fistula was not possible, and the aneurysmal segment was excluded. To our knowledge, this is the first report of aortic exclusion being used as the surgical treatment of an aortocaval fistula.