USE OF SURGICAL METHODS OF TREATMENT FOR THROMBOSIS OF THE INFERIOR VENA CAVA SYSTEM

Abstract

Objective. Develop surgical tactics in the treatment of acute deep venous thrombosis (DVT) of the inferior vena cava system.Materials and methods. We analyzed the results of the surgical treatment of 181 patients with DVT for the period from 2001 to 2014. Among the patients with DVT in our study, 37 (20.4%) patients had thrombosis of the inferior vena cava (IVC). Separately, we selected a group of 44 patients with floating DVT. During the treatment, catheter-directed thrombolysis (CDT) was used in 60 (33.1%) patients, systemic thrombolysis in 30 (16.5%), thrombectomy was performed in 44 (24.3%) patients, and anticoagulants were used in 47 (25.9%) patients. Catheter-directed thrombolysis was performed according to the developed method in 30 patients. Results. In the general assessment of the efficiency of the methods, we found that the efficiency of the patented method is 20.5% greater than the efficiency of thrombolysis in the back vein of the foot and 39% greater than the efficiency of systemic thrombolysis (p<0.001). In our study, out of 60 cases of CDT, hemorrhagic complications occurred in 2 (3.3%) cases. In the treatment of patients with floating DVT, we used active surgical tactics when the length of the floating part was more than 4 cm. In the treatment of occlusive thrombosis of the IVC, catheter-directed thrombolysis was used in 9 patients, systemic thrombolysis in 4 patients, and thrombolysis for pulmonary embolism (PE) in 1 patient. 1 patient with thrombosis of the vena cava inferior died of massive PE during anticoagulant therapy. The use of combined methods of DVT treatment of the IVC system made it possible to obtain good and satisfactory results in the immediate period in 166 (92%) patients and in the long-term period in 90 (49.7%) patients.Conclusions. Treatment tactics for thrombosis of IVC system requires an individual approach in each specific case, taking into account the etiological factors of the disease, anatomical features of the structure of IVC system, terms from the onset of the disease, the risk of pulmonary embolism (PE), the presence of concomitant pathology.