How many times do we initiate a thing only to stop it and restart it all over again.Same holds true for the surgical management of acute DVT.
It all started in the late forties when people with swollen limbs used to get operated by their attending surgeons and the big clot used to be removed from the veins of their legs.This procedure fell into disrepute and for years together the art of DVT thrombectomy was lost in wilderness.The reason was the recurrence of thrombosis in these patients.Even I was told by one of the vascular surgeons of that era who happened to be a great vascular surgeon himself that the surgery was messy and the patient ended up losing hell lot of blood.
People tried managing these acute DVT patients conservatively without attempting this so called ‘MESSY’ surgery.But something that has potential cannot be curbed for long especially in a scenario where we talk of ‘EVIDENCE BASED MEDICINE’.
There has been a constant tussle between the Europeans and the Americans concerning SURGICAL VENOUS THROMBECTOMY.Europeans esp.Germans kept doing surgeries for patients with acute DVT with good results whereas the Americans were circumspect about this treatment modality and were happy managing these cases conservatively resulting in a significant increase in morbidity.
Much to my surprise the recent guidelines from ACCP(AMERICAN COLLEGE OF CHEST PHYSICIANS) in 2008 finally accepted the role of surgery for ACUTE DVT and approved VENOUS THROMBECTOMY in patients with extensive ILIOFEMORAL DVT.CATHETER DIRECTED THROMBOLYSIS is the other treatment modality they suggest in patients with low risk of bleeding.
Why surgical venous thrombectomy failed in the forties is self evident.Patient selection was poor,concept of full heparinisation and early ambulation was not there and surgeons never had this concept of constructing an AV Fistula along with.With these things in the kitty of a vascular surgeon now,surgical results have improved remarkably and are far better than treating patients with anticoagulation alone.
My personal experience and the experience I carry from my stint with DR W.SANDMANN in Germany(A PERSON WHO CARRIED DOING VENOUS THROMBECTOMIES WITH CONVICTION INSPITE OF ALL ODDS WITH REMARKABLE RESULTS) suggests me to keep practising this treatment modality for the results are good and a slow acceptance by the practicing vascular surgeons all over the world is very much on cards.
Hope more vascular surgeons in India join me to propagate and practice SURGICAL VENOUS THROMBECTOMY as I too need company to tread this long journey of professional life.Afterall its not about 'ME',its about 'US'.
NOT KNOWING IS IGNORANCE BUT NOT WILLING TO KNOW IS DISASTER.
