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INTRODUCTION Mechanistic methods for preventing fatal pulmonary infarction due to thromboembolism have challenged the imagination of surgeons since Trendelenberg first proposed pulmonary embolectomy in 1908.30 Ligation of femoral veins, first proposed by Homans in 193411 has been subjected to extensive trial and study and has been found wanting.4,13,17 Iliofemoral thrombectomy, introduced by Läwen in 1938,16 is currently experiencing a rebirth of interest and may be effective in acute processes.5,10 Permanent ligation of the vena cava, also first suggested by Homans12 in 1944, has most successfully withstood the test of time and has undoubtedly saved many lives.23Although some surgeons15,23 minimize its importance, many patients experience significant postligation ulceration or edema after caval ligation.26 This has provoked other investigators to continue their search for a better method. Streuter and Paine (1951),29 Pualwan et al (1954),24 and Dale (1958)3 presented |
