Bergantini Helio, Raymundo Selma Regina de Oliveira, Miquelin Daniel Gustavo, Russeff Gleison Juliano da Silva, Silva Desirée Francini Del Frari, da Silva Gabriela Leopoldino, Galeti Amabile Oficiati de Carnevale, Dos Santos Matheus Pietraroia
Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, SP, Brasil.
Hospital Austa de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
J Vasc Bras. 2020 Nov 16;19:e20200075. doi: 10.1590/1677-5449.200075.
Free-floating thrombus in the deep venous system has a high potential to cause pulmonary embolization. It can also be found in patients with superficial venous thrombosis (SVT) that extends to a deep vein. There are still no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments with vena cava filter implants, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. We present the case of a patient with extensive deep venous thrombosis affecting the iliofemoral-popliteal territory with a floating thrombus extending from the left common iliac vein to the inferior vena cava. Treatment was performed with fibrinolytic therapy delivered with a multiperforated catheter, supplemented with anticoagulation with heparin and daily control angiography. At the end of the treatment, a significant stenosis was identified in the left common iliac vein, and angioplasty was performed with stenting.
深静脉系统中的游离血栓极易引发肺栓塞。在延伸至深静脉的浅静脉血栓形成（SVT）患者中也可发现此类血栓。文献中仍未明确规定治疗标准，治疗方法多种多样，从使用腔静脉滤器植入的抗凝和纤维蛋白溶解治疗，到开放式或血管腔内血栓切除术，再到诸如结扎静脉系统的手术中断等更具侵入性的手术。我们报告一例广泛的深静脉血栓形成患者，累及髂股-腘静脉区域，有一个从左髂总静脉延伸至下腔静脉的漂浮血栓。采用多穿孔导管进行纤维蛋白溶解治疗，并辅以肝素抗凝和每日血管造影控制。治疗结束时，发现左髂总静脉存在明显狭窄，并进行了支架置入血管成形术。
