Цель. Разработать дифференцированную хирургическую тактику при лечении пациентов с тромбо-зом глубоких вен (ТГВ), осложненным тромбоэмболией легочной артерии (ТЭЛА).Материал и методы. Проанализированы результаты лечения 58 пациентов с ТГВ, которые осложни-лись ТЭЛА. Пациентов с высоким риском ранней смерти по классификации Европейского общества кар-диологов было 9 (15,5%), промежуточным риском -14 (24%), с низким риском -35 (60,5%). В 55 случаях (94%) причиной тромбоэмболии легочной артерии был ТГВ, в 3 случаях (6%) причину ТЭЛА обнаружить не удалось. ТГВ проксимальной локализации наблюдался в 46 (79%) случаях. Системный тромболизис ТГВ, осложненных ТЭЛА, проводился в группе пациентов с высоким и промежуточным риском ранней смерти в 16 (69,5%) случаях. Катетер-управляемый тромболизис проводился при илеофеморальных ТГВ, осложненных ТЭЛА, в группе пациентов с низким риском ранней смерти и в сроки развития тромбоза до 7 суток в 10 (28,5%) случаях.Результаты. Значительное улучшение состояния пациентов, которым проводили тромболитическую терапию, было констатировано в 21 (82%) случае. Частичное улучшение состояния пациентов, которым использовали антикоагулянтную терапию, было выявлено в 17 (67%) случаях. Оно проявлялось в умень-шении одышки, тахипноэ, боли за грудиной, кашля. По данным СКТ полная дезобструкция легочного дерева была обнаружена в 3 (5%) случаях. Геморрагических осложнений при исследовании не наблюдалось. Ни одного летального случая отмечено не было. В течение периода исследования рецидивирующих ТЭЛА констатировано не было.Заключение. Системный тромболизис ТГВ, осложненных развитием ТЭЛА, показан в группе паци-ентов с высоким и промежуточным риском ранней смерти. Катетер-управляемый тромболизис показан при илеофеморальных тромбозах, осложненных ТЭЛА, в группе пациентов с низким риском ранней смер-ти и в сроки развития тромбоза до 7 суток. Ключевые слова: тромбоз глубоких вен, тромбоэмболия легочной артерии, классификации Европейского обще-ства кардиологов, тромболитическая терапия, лечение, системный тромболизис, катетер-управляемый тромболизис Objectives. To develop differentiated surgical tactics in treatment of patients with deep venous thrombosis (DVT) complicated by pulmonary embolism (PE).Methods. The treatment results of 58 patients with DVT complicated by PE had been analyzed. There were 9 (15,5%) patients with higher early risk of death according to the classification of European Society of Cardiology (ESC), 14(24%) -with intermediate risk and 35 (60,5%) -with a low risk. In 55 cases (94%) a majority of pulmonary embolism are caused by DVT, and in 3 cases (6%) the cause of pulmonary embolism could not be found. DVT of the proximal localization was observed in 46 (79%) cases. Systemic thrombolysis of DVT complicated by PE was carried out in the group of patients with higher and intermediate early risk of death in 16 (69,5%) cases. Catheter-guided thrombolysis was conducted at ileo-femoral DVT complicated by PE in the group of patients with low risk of early death and in terms up to 7 days in 10 ...
The aim. Treatment of venous thromboembolism remains perhaps the most challenging problem of modern phlebology. The aim of our study was to analyze current data and guidelines on the use of surgical and minimally invasive approaches in the treatment of pulmonary embolism (PE) and to compare these with our own results. Materials and methods. The results of treatment of 168 patients with PE, who underwent inpatient treatment at the clinic from 2009 to 2021, were analyzed. Among them, 162 (96%) patients had deep vein thrombosis, in 6 patients the cause of PE could not be identified. Recurrent PE was observed in 2 patients. PE with a high risk of death was observed in 51 (30.3%) patients, with a medium and low risk of death in 117 patients (69.6%). Systemic thrombolysis was performed in 44 (26%) cases. In 5 (2.9%) cases, vena cava filters were implanted. One (0.6%) patient underwent aspiration thrombectomy of the pulmonary artery using an Aspirex catheter. Two (1.1%) patients underwent pulmonary artery thrombectomy using an artificial circulation device. Results. Significant improvement in patients treated with thrombolytic therapy was observed in 40 (92.8%) cases. After surgical treatment of PE, significant improvement was observed in 100% of cases, 2 patients after PE showed complete de-obstruction of the pulmonary artery. No hemorrhagic complications were observed during the study period. No fatalities were reported. No recurrent PE was observed during the study period. Conclusions. The choice of treatment for PE is determined by the degree of the impact on the pulmonary tract, the stability of the patient’s condition, indicators of dysfunction of the right heart, the period from the onset of the disease, the risk of death. The use of aspiration thrombectomy using an Aspirex catheter (Straub, USA) and pulmonary artery embolectomy in the absence of thrombolytic therapy allows to obtain satisfactory results in patients with PE.
Introduction To date, the problem of venous thromboembolism and its consequences remains relevant, despite significant progress in the development of phlebology and technologies. Aim In our study, we tried to assess the “danger” of floating DVTs, methods and features of conservative and surgical treatment of patients with floating DVTs, analyze the results of treatment of this group of patients, and draw conclusions based on our data. Materials and methods The results of treatment of 1297 patients with venous thromboembolism for the period 2011–2022 were analyzed. 104 patients were treated with floating deep vein thrombosis, 1193 patients had occlusive proximal venous thrombosis. Results In our study, we determined the danger of floating DVT by comparing the facts of the migration of thrombotic masses in the proximal direction according to the results of treatment in two groups of patients. The first group consisted of 10 patients with proximal floating venous thromboses who were implanted with cava filters, the second group consisted of 28 patients with occlusive proximal venous thrombosis who were implanted with cava filters. Embolism occurred in 40.0% of cases floating DVT, while no cases of embolism were detected in occluding DVT ( p < 0.01). Groups of patients with the length of the floating part of the thrombus up to 5 cm were analyzed. Anticoagulant therapy was used in 42 cases; thrombectomy was performed in 52 cases. There was no case of pulmonary embolism when treated with both conservative and surgical methods. Conclusions Based on our research, it can be stated that floating thrombosis of deep veins of proximal venous segments is a type of thrombosis that has an increased risk of thromboembolic complications when the length of the floating part is 5 cm or more.
The aim. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients. Materials and methods. Patient B., a 36-year-old man, applied to the vascular surgery clinic of the Vinnytsia Regional Pyrohov Clinical Hospital in July 2010 with complaints of pain, swelling, cyanosis of both lower extremities, which bothered the patient for about 10 days. The patient had no history of venous insufficiency of both lower extremities. An objective examination revealed cyanosis and swelling of both lower extremities. A duplex scan of both lower extremities revealed hyperechoic iliofemoral thrombosis of both lower extremities. Aplasia of the IVC was diagnosed. The common iliac veins on both sides formed a collateral that flowed into the left renal vein. The infrarenal segment of the inferior vena cava was absent. Thrombosis spread from tibial to popliteal, femoral, iliac veins with venous collateral thrombosis up to the level of the left renal vein. The patient received enoxaparin at a dose of 1 mg per kg of body weight twice a day for 7 days with subsequent transition to warfarin under the control of international normalized ratio. Warfarin was prescribed from a starting dose of 5 mg with subsequent control of international normalized ratio in the range of 2.0-3.0. Venotonic and anti-inflammatory drugs were also prescribed. In combination with drug therapy, class 2 elastic compression stockings were recommended. After the treatment, the patient’s condition improved, swelling and cyanosis of both lower extremities regressed. Repeated duplex scanning at the discharge of the patient from the hospital after 7 days showed signs of initial recanalization of the affected venous segments and no progression of thrombosis. Conclusions. Thus, this clinical case showed that the use of anticoagulant therapy allows to obtain satisfactory results in the treatment of patients with congenital anomalies of the development of IVC, to avoid the development of pulmonary embolism and other life-threatening conditions. At the same time, such patients need regular follow-up examinations in order to adjust the treatment and prevent the development of IVC syndrome.
The aim. Treatment of venous thromboembolism continues to be one of the most controversial problems of modern angiology. This issue is especially relevant in the treatment of patients with traumatological pathology. Methods. Treatment of 1915 patients with fractures of lower extremities from 2017 to 2022 at the Vinnytsia Regional Pyrohov Clinical Hospital was analyzed. During the study period, 727 (38%) deep vein thromboses were diagnosed. Results. During the study period, 4 (0.2%) pulmonary embolisms were diagnosed, among which 3 (0.15%) were fatal. In 99.5% of patients with venous thrombosis and injuries, it was possible to achieve clinical improvement and regression of the thrombotic process. Conclusions. Treatment tactics for trauma patients with venous thromboembolism should be individualized and take into account the severity and localization of the injury, the need and urgency of trauma surgery, the risk of pulmonary embolism.
We analyzed the results of surgical treatment floating DVT. Unfortunately, there are no randomized studies in the world regarding the determination of clear tactical approaches to the treatment of floating venous thrombosis, in many cases doctors make decisions about the choice of surgical tactics based on their own experience. In our research, we tried to systematize our own experience and form the basic principles of determining surgical tactics in the treatment of floating venous thrombosis. To date, anticoagulants, surgical interventions in the form of thrombectomy, and thrombolytic therapy are used in the treatment of DVT. Unfortunately, at the moment, no consensuses clearly define the issues of surgical treatment of floating venous thrombosis, venous thrombosis in pregnant women, venous thrombosis complicated by pulmonary embolism, venous thromboembolism. The goal. The aim of the research was to develop a surgical tactics in the treatment of floating DVT of the inferior vena cava. Materials and methods. The treatment of 76 patients with floating DVT from 2008 to 2020 were analyzed. In a research among patients with floating DVT in 15(20%) patients experienced thrombosis of the inferior vena cava, 19(25%) patients had ilio-femoral thrombosis in 17(22%) patients with femoral - popliteal thrombosis in 9(12%) patients with popliteal - tibial. Deep vein thrombosis complicated by pulmonary embolism with medium and high risk of death was observed in 10 (13%) patients. Among them, floating thrombosis of the iliac-femoral segment was observed in 4 patients. Floating thrombosis of deep veins in pregnant women was observed in 6 (8%) patients. Among patients, 20 (296%) patients were admitted within 1 day of the onset of the disease, 30 (39%) patients on 2-3 days, 11 (14%) patients on 4-7 days, 8 on 8-14 days (11%) patients, from the 15th day - 7 (10%) patients). The results. Patients with long of floating part of the more than 4 cm, we used an active surgical tactics. In the presence of the floating thrombus a total iliac vein thrombectomy we performed in 12 patients with the removal of the floating thrombus with femoral access. For the prevention of pulmonary embolism in these cases we implanted a temporary cava-filter. When flotation thrombus in the external iliac vein, we used the technique of thrombectomy using Fogarty two catheters in 12 patients. When flotation clots in common femoral vein and distally using a vein thrombectomy with clamping head above floating thrombus. When treating patients with floating DVT, pulmonary embolism complicated with medium and high risk of death, we used systemic thrombolysis with pre- implantation temporary coffee filter in patients with floating DVT, pulmonary embolism complicated with medium and high risk of death, we used systemic thrombolysis with pre- implantation temporary coffee filter. In the presence of pregnancy and floating thrombosis thrombectomy was performed with the removal of the thrombus floating. In our research, when performing the surgical treatment of DVT no cases of pulmonary embolism during or after treatment were observed. In 100 % of patients after treatment has been a clinical improvement in all cases floating DVT was eliminated floating nature of the danger of thrombosis and pulmonary embolism. Conclusions. In the presence of a floating DVT of the inferior vena cava system with a length of the floating part of the thrombus greater than 4 cm, it is necessary to use an active strategy of thrombus removal. When performing thrombectomy, it is necessary to use methods of surgical prevention of PE, taking into account the localization of the floating part.
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