Surgical Prophylaxis of Pulmonary Embolism

John Hunter is credited with the first reported venous ligations for the treatment of suppurative thrombophiebitis in 1784.’ However, ligation of the inferior vena cava (IVC) to prevent the progression and embolization of infected thrombi in patients with puerperal sepsis was first recommended by Trendelenberg in 1910. Little attention was paid to the potential need for venous interruption until 1934, when Homans2 suggested that ligation of the femoral vein be performed to prevent pulmonary embolism. However, since such a limited procedure could not provide protection against pulmonary emboli in all cases, Homans3 revised his recommendation to include ligation of the IVC when there was reason to suspect that the source of the emboli was above the inguinal ligament. Although this operation successfully prevented pulmonary emboli, it was associated with an