Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 44-1976

Prophylactic inferior vena cava clipping in colonic surgery

Incidental prophylactic inferior vena cava clipping (IVCC) has been used in 30 patients undergoing colonic operations. The results obtained compare quite favorably with other methods of preventing postoperative pulmonary embolism (PE). This procedure would be justified in patients with a postoperative PE risk greater than 5 to 10 per cent. Practical criteria to identify this group of patients are presented, and the value of utilizing a risk profile is emphasized. There is no mortality from the procedure itself, and the morbidity was limited to lower-extremity edema in three patients who otherwise could have been expected to develop PE. The edema lasted two months in one patient and cleared rapidly in the other two. Attesting to the procedure's effectiveness, there were no cases of recurrent PE. Caval partition is an appealing mode of prophylaxis in high-risk patients because of its safety, efficacy, and permanence.

The hypercoagulability states

Although interest in coagulation has usually centered about the various hemorraghic disorders, it is hyperactivity of the hemostatic system with its thrombotic complications which has a far greater clinical impact. The hypercoagulability states are a vague group of disorders not well defined by the laboratory. They fall into two distinct groups: (1) conditions promoting venous thrombosis by activating the coagulation mechanism and (2) conditions promoting arterial thrombosis by platelet plug formation. Dealing with both of these groups separately the various disorders associated with a hypercoagulable state are discussed as well as their pathophysiologic basis; Special emphasis is placed on the laboratory evaluation of these disorders.