Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3656_Библиотеки_им_академика_М_И_Перельмана

was approached as a strategy for PE prevention. Bottini is credited with the rst successful caval ligation in a setting of trauma, but Homan was the rst to hypothesize that embo­lization of lower extremity thrombus could be prevented through bilateral ligation of the femoral veins. techniques failed to prevent recurrent PE, Collins and Nelson,2 and subsequently Homan,3 proposed infrarenal ligation of the IVC as a strategy for PE prevention. Early IVC ligation involved a laparotomy under general anesthe­sia in patients with signicant pulmonary hypertension, right heart failure, and associated oxygenation decits, and thus was associated with unacceptably high mortality, rang­ing from 4% in low-risk patients to 39% in patients with sig­nicant cardiac disease.4 Morbidity from the procedure was also substantial and included lower extremity edema, stasis ulceration, and post-thrombotic syndrome. Also of signi­cance, ligation of the IVC was associated with an incidence of recurrent PE of up to 15% through the development of collateral vessels around the ligated segment. Surgical vena caval interruption techniques involving suture or staple grids, and external caval clips were also later developed in an eort to preserve channels for blood ow in the IVC while entrapping signicant thrombus within caval seg­ments. ese techniques, although improvements from IVC ligation, were also fraught with complications, yet remained standards of therapy until less morbid treatments became available.