Vena Cava Thrombosis After Plication for Pulmonary Emboli

IN THE TREATMENT of recurrent pulmonary emboli, many operative approaches have been advocated. These include femoral ligation, inferiorvena-cava (IVC) ligation,1,2and, more recently, partial caval interruption with a "harp-grid" suture filter,3suture plication,4or Teflon clips.5 6The partial interruption techniques all attempt to avoid the postligation sequelae of edema, pain, induration, chronic dermatitis, and ulceration by preserving the caval flow while preventing any large emboli from passing the site of caval filtration.7 A dreaded and anticipated complication of all partial interruption techniques is thrombosis of the middle segment of the IVC and the renal veins. To our knowledge, this complication has not been reported. Thus, in addition to all the complications of IVC thrombosis,8there also would be the problems of renal-vein thrombosis9,10in the same patient. This report describes such a patient in whom propagation of a thrombus beyond a "Miles"