The experience with the treatment of floating thrombi in the inferior vena cava system
Abstract 368 patients with inferior vena cava (IVC) acute thrombosis aged 17 to 85 years were examined in order to develop the indications for surgical and endovascular treatment of IVC floating thrombosis and its evaluation. Floating thrombi were detected in 183 patients. The most common floating thrombus location was common femoral vein (CFV). In 112 cases, thrombosis started from the femoral vein (FV), in 50 from saphenofemoral junction. Symptoms of pulmonary embolism (PE) were established in 38 cases. Instrumental studies included ultrasound duplex scanning, contrast and computer venography, pulmonary perfusion scintigraphy. Thrombectomy procedure in the common, external iliac vein and CFV with FV was resection performed in 61 patients, in 23 of the cases it was performed with the temporary proximal arteriovenous fistula (AVF) imposition. FV resection was made in 28 cases. IVC thrombectomy with Traks device was performed in 6 patients. Cava filter implantation was performed in 74 patients with floating thrombosis. Permanent devices were implanted in 10 patients, removable in 64 cases. Retromboses in the early postoperative period were observed in 7 patients. Patients with AVF did not have thromboses. PE occurred in 5 patients a fatal outcome having happened in 2 cases. One patient died from myocardial infarction. Temporary vena cava filters were successfully removed in 32 patients in the period from 10 to 56 days. 69 patients were followed up during one to four years after the procedure for long-term results. Good results were achieved in 42 observations, satisfactory in 21, and poor in 6 cases. Patients after surgical and endovascular treatment (3.71±0.43) had significantly better integral component of VCSS (Venous Clinical Severity Score) scale than patients after conservative IVC thrombosis treatment (4.79±0.52, p<0.001). Active treatment strategy of floating thrombus with embolism risk is an effective measure for preventing pulmonary embolism and post-thrombotic disease development.
Keywords:floating venous thrombosis, ultrasound angioscan, thrombectomy, vena cava filter, pulmonary embolism
Clin. Experiment. Surg. Petrovsky J. 2015. № 3. Р. 36–44.
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