Results of a comprehensive approach to the treatment of deep vein thrombosis of inferior vena cava
The aim of our study was to develop based on our own experience differentiated surgical tactics in patients with deep venous thrombosis, complicated with pulmonary embolism, in accordance with datas evidence-based medicine. The results of treatment of 130 patients with venous thromboembolism were analyzed. Among them, there were 58 patients with DVT, complicated by pulmonary embolism and 72 patients with venous thrombosis of different localization, of which 45 patients were diagnosed with floating thrombosis. Patients with high risk of early death for the classification of the European Society of Cardiology was observed in 9 cases (15,5 %), intermediate risk in 14 cases (24 %), with low risk in 35 cases (60,5 %). DVT proximal localization was observed in 46 (79 %) cases. In 55 cases (94 %) cause of pulmonary embolism was DVT, in 3 cases (6 %) the cause of pulmonary embolism could not be found. Therapeutic tactics depended on the massiveness of the defeat of the pulmonary artery and the level of risk of early death related to pulmonary embolism. Systemic thrombolysis of deep venous thrombosis, complicated with pulmonary embolism, conducted in patients with high and moderate risk of early death in 16 (69,5 %) cases. Catheter-directed thrombolysis was performed in patients with iliofemoral DVT, complicated with pulmonary embolism, in patients with a low risk of early death and in terms of thrombosis up to 7 days in 10 (28,5 %) cases. The choice of an adequate treatment strategy in patients with DVT, complicated with pulmonary embolism, get us possibility of satisfactory results and significant clinical improvement in 82 % of cases. At club-femoral floating thromboses in a period of up to 7 days, thrombectomy was performed in 16 patients with femoral access. For the prevention of pulmonary embolism, methods for removing the thrombus using 2 Fogarty catheters were used. No mortal case was noted. During the period of the study of recurrent pulmonary embolism, no recurrence was noted. The choice of the surgical method of treating DVT is determined by the localization and prevalence of the process, the period from the onset of the disease, the severity of the concomitant pathology. Thrombectomy is indicated in the ineffectiveness of thrombolysis. In later times it is necessary to remove the floating part of the thrombus. In the presence of floating DVT and contraindications for surgical intervention, it is necessary to apply means and methods for the prevention of pulmonary embolism. Absolute indications for thrombectomy with DVT are blue limb extremity, against indications before thrombolytic therapy. Systemic thrombolysis of DVT, complicated by the development of pulmonary embolism, is shown in the group of patients with high and average risk of early death. Catheter-controlled thrombolysis is indicated for ileophlebal DVT, complicated by pulmonary embolism, in a group of patients with a low risk of early death and in terms of thrombosis up to 7 days. Anticoagulation therapy is indicated with distal occlusive DVT and low risk of early death.
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