Ivanov A V, Sakharov A B
Tsentral'naia klinicheskaia bol'nitsa Meditsinskogo tsentra Upravleniia delami Prezidenta RF, Moscow.
Khirurgiia (Mosk). 2004(1):4-7.
Prophylactic measures carried out in 32,400 patients permitted to decrease significantly the rate of thrombosis of lower extremities deep veins (to 2.2%). Use of standard and low-molecular heparin led to a similar rate of thrombus formation (2.4 and 2.0%), but the number of hemorrhagic complications in use of the later decreased (3.8 and 0.6%, respectively). Among 902 inpatients with thrombosis, lesion of distal segment of the lower extremities venous bed was revealed in 25.5%, femoral-popliteal - in 43.3%, ileofemoral - in 31.2% patients. Floppy emboli-dangerous thromboses were diagnosed in 19.1% cases. Cava-filter was implanted when floppy thrombus was in proximal part of iliac vein or in infrarenal segment of inferior cava vein only. When embologenous thrombus was lower to inguinal fold thrombectomy was performed with subsequent plication of superficial femoral vein. 3 years after cava-filter implantation chronic venous insufficiency in both less of II degree was seen in 45.2% patients, III degree - in 24.1%, thrombosis of inferior cava vein - in 1.3% patients. In plication of superficial femoral vein chronic venous insufficiency of II degree was revealed in 9.2% patients, III degree - in 1.7 cases. It is recommended to perform thrombectomy with plication of superficial femoral vein when floppy thrombus is located in ileo-femoral segment to prevent pulmonary artery thromboembolism.
