Surgical prevention of pulmonary embolism in patients with lower extremities' decompensated chronic venous insufficiency

Abstract

Introduction. Allocation into a separate group of patients with embolo-threatening (floating) thrombi has important practical significance for determination to the tactics of surgical treatment, establish the expediency and urgency of surgical intervention. According to European recommendations, the main method of treatment of acute varicothrombophlebitis (AVT) is the appointment of anticoagulant therapy. In the absence of ultrasound control, the patient's non-compliance with medical recommendations, economic difficulties in a particular patient – surgical methods of treatment are offered. The aim of the study. To improve the results of surgical treatment of patients with acute varicothrombophlebitis against the background of venous blood flow decompensation and minimize the possibility of spreading thrombosis to deep veins and the occurrence of pulmonary embolism (PE). Materials and methods. An analysis of the surgical treatment of 104 patients with AVT on the background of decompensated chronic venous insufficiency corresponding to class C6 according to the CEAP classification was carried out. Patients were divided into two groups. In 60 patients of group I, the cause of decompensated chronic venous insufficiency was varicose veins of the lower extremities. 44 patients of the II group were diagnosed with post-thrombotic syndrome of femoro-popliteo-tibial localization in the stage of incomplete recanalization. All patients of both groups were operated on for AVT of great and small subcutaneous veins systems. Results and discussion. The transition of the thrombotic process from superficial to deep veins was detected in 28 (26.9%) patients, namely: in the I group are 12 (20.0%), and in the II group are 16 (36.4%) patients. This indicates a sufficiently significant percentage of patients with a seriously complicated course of decompensated chronic venous insufficiency. Thrombectomy from the femoral and external iliac veins was performed in 8 patients of the I group and 6 patients of the II group. This surgical intervention requires full visual control of the mouth of the great saphenous vein and exposure of the femoral vein sufficient to block blood flow through it. A floating thrombus in the popliteal vein was detected in 14 (13.5%) patients: 4 from the I group and 10 from the II group. All patients underwent urgent radical phlebectomy of the small saphenous vein with removal of floating blood clots from the popliteal vein. After removal of floating thrombi and removal of thrombosed veins on the thigh and lower leg, comprehensive conservative treatment of trophic ulcers was applied, which included: various multicomponent bandages, various types of necrotomy, vacuum therapy, autodermoplasty. In a year, trophic ulcers were healed in all patients of the first group, and in 97.7% of patients of the second group. During the entire observation period of the patients, no cases of PE were registered. Conclusions. 1. Acute superficial thrombophlebitis is a frequent complication of varicose veins and post-thrombophlebitic syndrome and accounts for 40% of patients with venous pathology operated on in a hospital. 2. The dangerous floating nature of blood clots in the system of the small saphenous vein in patients with acute superficial thrombophlebitis against the background of postthrombophlebitic syndrome occurs almost 3.4 times more often than in varicose veins (22.7% compared to 6.7%). Which should prompt a more thorough ultrasound examination of such patients. 3. Complex radical surgical treatment of AVTF allowed reliable prevention of PE and contributed to rapid healing of trophic wounds.