Thrombectomy for acute iliofemoral thrombosis in prevention of pulmonary embolism

• Published in: Angiologii͡a︡ i sosudistai͡a︡ khirurgii͡a Vol. 25; no. 4; p. 181
• Main Authors: Kungurtsev, V V, Saraniuk, R I, Kungurtsev, E V, Chernov, A A, Zvereva, L S, Ianus, V M
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2019
• Subjects: Blood Vessel Prosthesis Implantation; Femoral Vein - surgery; Humans; Iliac Vein - surgery; Pulmonary Embolism - etiology; Pulmonary Embolism - prevention & control; Thrombectomy - methods; Treatment Outcome; Vena Cava Filters; Venous Thrombosis - complications; Venous Thrombosis - surgery; ultrasonographic angioscanning; open thrombectomy; arteriovenous fistula; cava filter; embologenic iliofemoral thrombosis
• ISSN: 1027-6661
• DOI: 10.33529/ANGIO2019422

Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.