-Report on Experiments and Clinical Cases-

Surgical Venous Thrombectomy for Japanese Patients with Acute Deep Vein Thrombosis: A Review of 5 Years' Experience

Noriyoshi Kutsukata^1,2, Kunihiro Mashiko^1,2, Hisashi Matsumoto^1,2, Yoshiaki Hara^1,2, Yuichiro Sakamoto^1,2, Hiroyuki Yokota¹, Hitoshi Yamauchi³ and Masami Ochi³

¹Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School
²Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital
³Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School

Objective: Deep vein thrombosis (DVT) is a major risk factor for pulmonary thromboembolism (PTE). We carefully selected patients for surgical thrombectomy to treat acute-phase thrombosis and obtained favorable results.
Methods: Over the past 5 years, we have performed surgical thrombectomy via a minimum femoral skin incision in 11 patients. Surgery was considered for patients with persistent phlegmasia cerulea dolens, despite thrombolytic therapy. All of our patients underwent surgery within 14 days of the onset of symptoms. During the operation, the patients were kept in the supine anti-Trendelenburg position to prevent PTE, and general anesthesia was maintained with positive-pressure mechanical ventilation. Blood flow to the inferior vena cava was occluded with a blocking catheter, and thrombectomy was performed with a thrombectomy catheter inserted parallel to the blocking catheter. A cell separator device was used effectively for autologous blood transfusion. To prevent reocclusion and promote collateral perfusion, we constructed an arteriovenous fistula for an iliac venous spur.
Results: There were no major postoperative complications, such as PTE or peritoneal bleeding, and no cases of postthrombotic syndrome after an average 38.4 months of follow-up.
Conclusion: This surgical technique for venous thrombectomy is minimally invasive and safe for Japanese patients; surgical thrombectomy should be considered a treatment option for DVT in Japan.

J Nippon Med Sch 2010; 77: 155-159

Keywords
deep vein thrombosis, thrombectomy, Japanese

Correspondence to
Noriyoshi Kutsukata, Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inba-mura, Inba-gun, Chiba 270-1694, Japan
moonsong@nms.ac.jp

Received, December 11, 2009
Accepted, January 21, 2010