Prophylaxis of pulmonary embolism with trombosis of the inferior vena cava
DOI:
https://doi.org/10.24144/2415-8127.2018.57.86-91Keywords:
deep vein thrombosis, inferior vena cava, pulmonary embolism, thrombectomy.Abstract
The aim of research was to substantiate indices of surgical prophylactic of pulmonary embolism. Materials and methods. Has been analyzed the results of investigation and treatment in 790 patients with different forms deep thrombosis at inferior vena cava system. Patients were divided into the groups depending on the treatment. The first group consisted of 555 patients which performed the surgical treatment with the next conservative treatment. The first A group (n=380) consisted of patients which performed an open full or partial thrombectomy with or without surgical prophylactic of pulmonary thromboembolism. The first B group (n=50) consisted of patients which performed the combined treatment with surgical prophylactic of pulmonary thromboembolism. The first C group (n=125) consisted of patients which performed an operation with transfascial thrombosis. The second group (n=235) consisted of patients which performed only the conservative therapy. For investigation of patients were used the laboratory methods of examination, also the instrumental: ultrasound duplex scanning, X-ray phlebography, computer tomography and radionuclide fleboscintigraphy. During the radionuclide fleboscintigraphy at rest and during physical activity, the following indicators were determined: the average transport time of the radiopharmaceutical, the linear velocity of the blood and the loading index. Results. We offered the considerable attention to the definition of the variant of thrombotic lesion and the nature of thrombotic masses. The expansion of thrombotic occlusion is important for choosing the treatment method. The most patients – 441 (55,8%) – had lesion of one venous segment, the expansion of thrombotic masses in two venous segments founded in 167 (21,1%) patients, the lesion more than two venous segments observed in 182 (23,1%) of cases. Evaluated the upper and lower boundaries of thrombotic masses. The transition of thrombotic process from the superficial venous system to the deep caused the real threat of pulmonary embolism, in particular, in all 125 (100,0%) patients first C group, discovered the floating top of the thrombotic masses.The cumulative analysis the results of the treatment patients with thrombosis of inferior vena cava system during 3 years of follow-up showed that good and satisfactory results in the first A group were observed in 89,3%, in the first B group – 81,7%, in the first C group – 88, 4% and in the second group – 35,3% of patients. Conclusion. When choosing the indices for surgical treatment of thrombosis the inferior vena cava system, should be given to the cause of thrombosis, the nature of thrombotic masses, the variant and the spread of thrombotic lesion, the presence of flotation the top of thrombotic masses. The offered medical-diagnostic algorithm allows to effectively prevent the pulmonary embolism.
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