Prophylactic Interruption of the Inferior Vena Cava: Immediate and Long-Term Results

To determine the effects of prophylactic interruption of the inferior vena cava (IVC) the hospital course of 340 patients who underwent aortic operations with placement of a Moretz IVC clip between 1980 and 1988 was removed: 175 patients had had abdominal aortic aneurysm resection; 143, aortobifemoral by pass; and 22, aortobiiliac endarterectomy or bypass. There were no complica tions related to placement of the IVC clip. After operation, any clinical suspicion of deep vein thrombosis (DVT) or pulmonary embolus (PE) was docu mented by phlebography or pulmonary arteriography, respectively. In the im mediate postoperative period ( < thirty days), only 2 (0.5%) patients had a PE and 10 (2.9%) a DVT. For long-term follow-up extending to eight years (mean ± 42.8 months), 308 patients were available. During long-term follow-up, 2 (0.6%) patients had a PE and 7 (2.2%) a DVT. Limb edema without evidence of DVT occurred in another 7 (2.2%) patients. B-mode ultrasonography of the IVC was performed in 163 patients. The IVC was clearly patent in all but 5 (3%): 1 had had a documented PE in the immediate postoperative period, and the other 4, an asymptomatic occlusion of the IVC during late follow-up. Prophylactic IVC interruption in aortic surgical patients appears not to cause IVC thrombosis, to initiate DVT, or to cause chronic venous insufficiency. The results indicate that it is a safe method of decreasing the incidence of PE, without increasing operative morbidity.