FROM VENOUS LIGATION TO THE VENA-CAVA FILTER - THE EVOLUTION OF IDEAS - AIMS AND HAZARDS OF VENA-CAVA INTERRUPTION

Starting from the use of venous ligatures (the first measure employed), methods for the prevention of pulmonary embolism have been perfected to arrive now at the endocaval insertion of permanent or temporary filters. Both in the materials used and the techniques employed, major progress has been made and incidents and accidents (thrombosis, migration, perforation of the venous wall) have become rarer. The efficacy of classical treatment methods (anticoagulants, early mobilisation, hemodilution, etc.), the preventive value of which has long been recognised, must also be taken into account when making the decision. Specific indications for vena cava interruption procedures can be defined, but their very efficacy and the ease of insertion of filters have led to indications (on a prophylactic or adjuvant basis) which are often - and other than in special situations - dubious insofar as the prevention of embolism does not always require interruption of the vena cava and that complete freeing of the iliac veins is generally not a priority objective.