The natural history following venous ligation for civilian injuries

Contrary to prevailing views, documentation of major morbidity after venous ligation for trauma is sparse. Forty-six patients had ligation for injury to the major veins of the lower extremities, namely, vena cava (six), external iliac (five), common iliac (three), common femoral (eight), profunda femoris (six), superficial femoral (thirteen), and popliteal (five). The post-ligation management included: 1) early and extensive fasciotomy when indicated, 2) initial strict bed rest with elevation until edema free, 3) trial ambulation for 2 hours, 4) added elevation if trial ambulation leads to recurrent edema. Forty patients were discharged edema free, and six patients had mild edema. Followup examination in 39 patients revealed no edema in 30 patients, mild edema requiring no treatment in one patient, and moderate edema requiring support hose in eight patients. No severe or massive edema causing ulceration or ischemia occurred. Based on these findings, primary venous interruption is a safe, quick and effective means of managing venous injury whenever the extent of injury or the severity of associated injuries make primary repair hazardous.