Current status of surgical therapy for deep vein thrombosis.

There is renewed interest in the use of operative thrombectomy in the management of acute DVT using the adjuncts of heparin infusion through an indwelling catheter and pneumatic segmental compression of the leg. In the absence of phlegmasia cerulea dolens, however, the indication for thrombectomy remains unresolved. For the postthrombotic syndrome, the most widely accepted procedure is the Palma femorofemoral cross-over bypass, which is indicated for relief of persistent unilateral iliac venous obstruction. Venous valvular incompetence is a much more challenging problem for which some limited success has been achieved by direct valvuloplasty, venous transposition, and autologous vein valve transplantation. For the most serious complication of venous thrombosis, pulmonary embolism, the evolution of mechanical devices has eliminated the need for direct approaches to the vena cava, and the long-term results with the Greenfield filter allow it to be placed in either an infrarenal or suprarenal position with assurance of long-term patency.