Initial clinical studies indicate that a new approach to vena cava ligation and use of heparin in patients with pulmonary embolic disease may prevent recurrent, often fatal embolization and chronic hypertension.
In the past, femoral vein ligation, and the apparently more effective method of extraperitoneal vena cava ligation, have been the two major surgical techniques used to prevent new pulmonary emboli which arise from the lower extremities and pelvic veins. However, several physicians have found that emboli recur regardless of these procedures in some patients.
Recently, an investigator from the University of Pittsburgh School of Medicine has suggested that these failures may be due, in part, to the location of the vena cava ligation.
Based on experimental work and clinical study of nine patients, W. Clayton Davis, MD, believes ligation should be performed transperitoneally—rather than extraperitoneally—immediately below or as close to the renal vein as possible. The vena cava should