Profilaxis of pulmonary embolism with transfascial thrombosis

Abstract

The aim — to substantiate indices to surgery prophylaxis of pulmonary embolism related to transfascial thrombosis in the inferior vena cava system.Materials and methods. The results of examination and surgery treatment of 125 patients with transfascial thrombosis have been analyzed, patients were admitted to surgical diseases department of Novak clinical hospital of Transcarpathia region in the period from 1995 to 2014. These were 47 (37.6 %) men and 78 (62.4 %) women. The age of the patients ranged from 16 to 83 years, the mean age was 53 ± 2.5 years. The frequency of transfascial thrombosis among the total number of treated patients (n = 1601) for acute varicotromboflebitis during the mentioned period was 7.8 % of cases. Patients underwent laboratory and instrumental examination, ultrasound Doppler and ultrasound duplex scanning (Aloka­3500, Japan; My Lab­50, Italy; HDI­1500 ATL­Philips; Ultima Pro­30, z.one Ultra, Zonare Medical Systems Inc., USA).Results and discussion. In 62 (49.6 %) patients, the proliferation of thrombotic process on the deep venous system was observed in the area of sapheno­femoral junction with the transition on the common femoral vein, the length of floating part of the thrombotic masses varied from 1.5 to 7.5 cm, on average 4.2 ± 0.7 cm. In 54 (87.1 %) patients, when spreading the floating top of thrombotic masses beyond the boundaries of sapheno­femoral junction of 3 cm length, thrombectomy was performed through the large subcutaneous vein orifice at the height of Valsalva test. 8 (12.9 %) patients underwent a venotomical section of the general femoral vein for thrombectomy. In 20 (16.0 %) patients, the spread of thrombotic process on the deep venous system was observed in the region of sapheno­popliteal junction with the transition to the popliteal vein. The length of floating part the thrombotic mass in spreading through the sapheno­popliteal junction varied from 1.5 to 5.5 cm, on average of 3.3 ± 0.5 cm. In 15 (75.0 %) patients it was possible to perform the thrombectomy from the popliteal vein through the orifice of the small subcutaneous vein. In 5 (25.0 %) patients were performed the venotomy of popliteal vein during thrombectomy. The transition of thrombotic lesion through the perforated veins of the shin was detected in 43 (34.4 %) patients. In this case, the localization of the top thrombotic masses in the shin veins was observed in 7 (16.3 %), in the leaf veins — in 16 (37.2 %), in the popliteal veins — in 17 (39.5 %) and in the surface popliteal veins — in 3 (7.0 %) patients. In 7 patients with localization on the top of thrombotic masses in the perforated vein, thrombectomy was performed from the perforated vein during the compression of the calf muscles and the ligation of the perforated vein. In 7 patients the ligation of the popliteal vein below the fall of the small subcutaneous vein was performed in order to prevent pulmonary embolism for the transition of thrombotic masses through the perforated veins on the shin. In 26 patients an open thrombectomy from the popliteal vein or the calf venous sinus with venotomy followed by ligation of affected venous sinuses was performed. In 3 patients with the spreading the process on popliteal and superficial femoral veins, the ligation of the superficial femoral veins below the fall of issue of the deep femoral vein was performed.Conclusions. In order to prevent the pulmonary thrombosis, the volume of surgical intervention should be extended. Patients with transfascial thrombosis, regardless the surgery redicality, should be treated as in the case of deep vein thrombosis.