Ligation of inferior vena cava for thromboembolism. Clinical and autopsy correlations in 119 cases

The correlation between surgically related mortality and preoperative condition or degree of heart failure was studied in 119 patients who had undergone ligation of the inferior vena cava for the treatment of thromboembolism. There were 18 related deaths (15%), of which 12 (10%) were associated with a poor or terminal preoperative condition, or class 4 heart failure. In patients with class 4 heart failure, related mortality was 55%, whereas in those with lesser degrees of heart failure, related mortality was 10%. When patients with class 4 heart failure were excluded from the analysis, the mortality in patients with and without heart failure was comparable (10% vs 7%). Pulmonary emboli were found in 31 of the 37 autopsies, a preoperative diagnostic accuracy of 84%. Autopsy revealed recurrence of pulmonary emboli after ligation in 3 of the 37.