The role of the venous collector to the determinate indications of a surgical treatment of deep vein thrombosis of the vena cava inferior system

Abstract

The aim of research was to determine the indications of a surgical treatment of deep vein thrombosis of the vena cava inferior system depending on the state of the collateral and magistral venous blood flow in the venous collector. Methods. The analysis is made of results examination and treatment of 790 patients with acute thrombosis in the vena cava inferior system and being treated at departments of angiosurgery and urology of the Transcarpathian Re-gional Clinical Hospital A. Novak and the surgical department of the Transcarpathian Regional Clinical Oncology Center during 2006 – 2016. For investigation of patients were used the laboratory methods of examination, also the instrumental: ultrasound duplex scanning, X-ray phlebography, computer tomography, radionuclide fleboscintigraphy and ultrasound scanning of heart. During the radionuclide fleboscintigraphy of patients at rest and during physical activity, the function of the muscle-venous pump of the tibial was evaluated: the average transport time, the linear speed of blood flow and the loading index. Results of research. 89,2% of cases the formation of the thrombus begins in the shallow muscle branches of the tibial, giving outset the medial group of the sural veins, and progresses from the bottom upwards, extending to the tibial and popliteal veins, and then to the femoral veins and above. By the nature of thrombotic masses were isolated the loose formed (organized) and the implantation tumor thrombs. 417 (52,8%) of patients revealed the loose thrombotic masses, 344 (43,5%) – the formed ones, and 29 (3,7%) – the implantation tumor thrombs. The most of patients (408 (73,5%)) the main group the occlusive nature of thrombotic lesion were detected, 129 (23,2%) of patients – parietal and 18 (3,3%) – fragmentary, including 403 (72.6%) of patients the main group with the proximal part of thrombotic masses having a floating nature. 162 (68,9%) of patients in control group the occlusive nature of thrombotic lesion was detected, 73 (31,1%) of patients – parietal. 34 (14,5%) of patients in control group a floating top of thrombotic masses was observed. The presence of fragmentary thrombus, which lost the fixation point, was considered as an absolute indication for the surgical treatment. The fresh, loose thrombotic masses that aren`t fixed to venous wall were considered as the most dangerous at pulmonary thromboembolism. The formed thrombus, especially with their occlusive nature, carried the less risk of pulmonary thromboembolism. Having the floating top of thrombotic mass, the length of free proximal thrombus part was estimated. With the length of free proximal thrombus part up to 4 cm, waiting tactics were selected, except the tip-shaped form of floating top in 8,7% of treated patients, which was considered as embolus and assumed as absolute indication for surgery. Due to the lack of anticoagulation therapy effect, the presence of tumour thrombus was considered as a direct indication to surgical treatment. If necessary the resection of the wall of vena cava inferior with tumour thrombosis in o rder to prevent the stenosis the latter, it was performed the aloplasty (defect of the vena cava inferior more than 1/3 of the circle) or aloprothesis (defect more than 2/3 of the circle) of the latter. Conclusions. At the segmental thrombotic occlusion of the main magistral the surgical treatment of the deep vein thrombosis showed only at the presence a floating top. At occlusion of the abduction magistral and venous collector the preference be given to thrombectomy. And at the presence of the floating top, the indications for surgical treatment become absolute. At affected of two venous colectors and their magistrals only the surgical intervention is able to restore the main magistral blood flow.