Thrombectomy for Ilio-femoral Venous Occlusion: The Youngest Reported Case By Charles

A. C. Clyne,

R. E. Cudmore, CASE

C;.I

LL 5 yr old boy. was admitted

nltls 31 whtch ttme psncreatitia

\*a\

A. 0.

and R. Galloway

REPORT

to a ncarbv lound.

Mansfield,

hospital

Therr\\a>

and underwent

no histork

laparotom~

of trauma

ltir perrto-

or prodromal

illneh\.

He recovered and was allowed home 3 wk later. One \*eek rtl’ter discharge anorexl;L and vomiting. lat wlutiony

through

a large quantlt) The t’olloaine

a cannuia

placed

a left femoral

Hey

Hohpital

He received

l’ollowing

intravenous

in 111sIel’t long saphenous and aszending

femoral

vejn.

venofraphy

I ).

vetn (1’1g.

venotom!

Operative

using a Fogarty

was not used. Lollobing

contirmed

Alder

tno

dais

amino

ot

acid

and

.4 laparotomt

revealed

demonstrated

the prc+

lluid.

tn the lel’t upper

vena cava cdthetcr

to

uab dlstended.

day his lel’t leg w:L:, a~ollcn

out through

venogram

he w,;I\ .tdmltted abdomen

of free hemorrhagic

cncc of thrombosis carried

Hi\

the removal

the free p~lr\age of contrast

from

removal

catheter.

of

An

of the clot

occluding

IO cm of thrumbus.

the lneuinal

region

was

inferior

an operatiLe

to the inferior

vena

cave (Fig. 2). He has then hrparlnl/ed. Scvrn dayx later 3.500 SamogzI hr appeared dqspnca. xan

hi\ abdomen

I

units. Glucagon to

hate

a good

and cheat x-ra)

onct‘ agn~n became

dlstended

mgm Intr~lvenousl)

Immedlatelg

result.

showed

The

same svening

an area of collapse

and his serum

amylabe robe 10

and IO mgm over the next 24

he collapsed

suspicious

with

hqpotenhion

of pulmonary

embolu>.

and L.unf

was not undertaken.

In

the

subsequent

pstro\tomy. At

l’ollou

that further

I yr

up

a

fortnight

He uas tinall) later

\snosraphy

pancreatic

dlhcharped there

developed

pseudocyst

home feelins

hell

with

wah nc, clintcal evidence

which

required

cgsto-

no leg edema.

of venous obstruction.

We did not feel

wa\Ju\tlllcd DISCUSSION

Phlebothrombosis

and pulmonary

this may be due to failure ticial thrombophlebitis

embolism

of diagnosis.’

appear to be relatively

their veins and probably may be important in the

literature

of the

deleterious

four

elrects

and deep vein thrombosis Venography

provided

et al. described

fat emulsion

infusion

case of phlebitis

poaslbly due to the shortness ol

in bed even when of the

upper

ill. Dehydration

are a number

“deeper”

and lower

limb

limb

of report5

vcln\.’

vein\

f-on-

following

preoperative

location

the Deparmenl

associated

OJ Vascular

acid holutlons

these solutions

through

are irritant

use at our hospital

in children

cannulae

In

to vessel walls. and neonate>

been observed. of the clot as emphasized

a successful ilio ~femoral

These were mostly

Liverpool.

and amino that

is in constant

has not previously

raised levels of factor V and then reviewed

From

of both

veins and it is well known

This route for intravenous

Hospital.

movement

of cannulation

cases of thrombosis

received intravenous

both long saphenous

in children.’

only one other

for fluid replacement.”

Our patient

Mack

that

although

a case of super-

IO yr.”

to venous thrombosis,

aided by their continued

of in children.’

and vessel wall injury may have played a part. There

talne et al. described cannulatlon

in the previous

immune

unheard

and Sussman described

in an X yr old girl and commented

had been recorded in the English literature Children

are practically

In 197 2. Marks

thrombectomy

42 cases of prevlousiy

with

Surgery.

localized

or systemic

Hammersmith

by Birzle and Reinwein.”

in a 51 yr old with reported

herrditaril)

deep vein thromboseh

inl’ections.

Hospital.

London.

and

Aider

H t,~,

England.

Journal of Ped,afric Surgery, Vol. 12, No. 5 (October), 1977

:703

CLYNE

Fig. in the

Fig. free

flow

2.

Postoperative of contrast

following

venogram, removal

showing of clot.

1. upper

Preoperative femoral

venogmm, vein.

showing

ET

AL.

clot

ILIO-FEMORAL

VENOUS

OCCLUSION

705

THROMBECTOMY

REFERENCES I.

Stienson

tenbive Surgery worth.

in

Egan

JJ.

Suenson

(ed 3) Vol

I. chap

MotTat

0

HL:

(cd).

In-

16. London.

Butter-

deep

J Pedlatr

\ein

Surg

throm-

i&534,

540.

5. Fontaine fondes

Pedlat 26:73Y. bosen

3. Marks In

JG

Jr,

an

X yr

Sussman old

girl.

SJ: J

ThromboPediatr

1. I-onkalsrud

X0:

PostInfusion

phlebitis

Clin

Pediat

In

Lasfargues thromboses cher

(Phlkt)

x:13: