Surgical prevention of pulmonary embolism

In an autopsy study of 919 patients who died during the decade from 1964 to 1973 with emboli (731 cases) or thrombi (188 cases) in the pulmonary arteries, the source of the emboli was believed to be the iliocaval segment in 63.8% and the femoral-popliteal segment in 36.2%. Phlebography was performed in 353 patients with acute phlebothrombosis or pulmonary embolism, and radioisotopic scintiscans with125I-fibrinogen were performed in 309 patients. Phlebography, particularly with the method of retrograde iliocavography, was of decisive importance in determining the indications for surgery to prevent pulmonary embolism by demonstrating floating thrombi in 37.5% of the cases. During the period 1971 to 1977, 173 operations were performed to prevent pulmonary emboli. These were thrombectomy in 59 patients, filter implantation in 44, vein plication in 10, vein ligation in 3, and combinations of these procedures in 57. Demonstration of a floating venous thrombus was considered an absolute indication for operation. The postoperative mortality rate was 9.2%, and the incidence of postoperative pulmonary embolism was 1.5%