RESUMEN
We present two clinical cases of successful endovascular treatment of proximal deep vein thrombosis following May-Thurner syndrome. In the first case, 2-day regional catheter thrombolysis, percutaneous mechanical thrombectomy and venous stenting were required to restore hemodynamics in the left lower limb. In the second case, regional catheter thrombolysis continued for 3 days with subsequent thrombotic mass lysis. However, iliac vein was severely narrowed that required venous stenting. Long-term results were favorable in both cases. Venous outflow has become almost normal after endovascular treatment. The patients' ability to work has been restored.
Asunto(s)
Procedimientos Endovasculares , Vena Ilíaca , Síndrome de May-Thurner , Stents , Trombectomía , Trombosis de la Vena , Humanos , Síndrome de May-Thurner/complicaciones , Síndrome de May-Thurner/terapia , Síndrome de May-Thurner/diagnóstico , Síndrome de May-Thurner/cirugía , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Trombosis de la Vena/cirugía , Trombosis de la Vena/diagnóstico , Procedimientos Endovasculares/métodos , Resultado del Tratamiento , Vena Ilíaca/cirugía , Trombectomía/métodos , Femenino , Masculino , Terapia Trombolítica/métodos , Persona de Mediana Edad , Adulto , Extremidad Inferior/irrigación sanguíneaRESUMEN
OBJECTIVE: To improve treatment outcomes in patients with late stages of total-subtotal deep vein thrombosis using pharmacomechanical thrombectomy. MATERIAL AND METHODS: We compared treatment outcomes in 2 homogeneous groups of patients with deep vein thrombosis and severe acute venous insufficiency. Standard anticoagulation (apixaban) was performed in the first group (n=20), endovascular treatment was applied in the second group (n=20). Regional catheter thrombolysis was performed at the first stage, and percutaneous mechanical thrombectomy was performed at the second stage. Incidence of hemorrhagic syndrome was assessed. The results were evaluated after one year considering patency of deep veins and severity of venous outflow disorders. RESULTS: Hemorrhagic complications occurred in 15% and 25% of patients, respectively. This required discontinuation of anticoagulation throughout the treatment and subsequent appointment of minimum doses of apixaban. Complete restoration of vein patency was observed in 20% and 55%, partial recanalization - 45% and 25%, minimal recovery - in 35% and 20% of patients, respectively. In the first group, venous outflow disorders were absent in 20% of patients, mild disorders were registered in 45%, moderate - 20%, severe - 15% of patients. In the second group, these values were 55%, 25%, 20% and 0% of patients, respectively. CONCLUSION: Pharmacomechanical thromboectomy can improve treatment outcomes.
Asunto(s)
Enfermedades Vasculares , Trombosis de la Vena , Humanos , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/métodos , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugía , Trombectomía/efectos adversos , Trombectomía/métodos , Vena Femoral , Resultado del Tratamiento , Enfermedades Vasculares/etiología , Anticoagulantes/uso terapéuticoRESUMEN
OBJECTIVE: To compare the efficacy of regional catheter thrombolysis with urokinase and alteplase for late proximal deep vein thrombosis. MATERIAL AND METHODS: We analyzed safety and effectiveness of treatment of 38 patients with late proximal deep vein thrombosis divided into 2 statistically homogeneous groups by 19 people. In the first group, regional thrombolysis with urokinase was performed with injection of the drug into thrombosed popliteal, femoral and iliac veins. Alteplase was used in the second group. Patients received rivaroxaban in pre-, perioperative period and throughout 6 months after surgery. Complications of endovascular therapy were recorded. After 12 months, ultrasound and clinical examination were carried out to assess vein recanalization and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. RESULTS: Minor hemorrhagic complications of endovascular treatment developed in 31.7 and 21% of patients, respectively. In the first group, complete vein recanalization occurred in 31.6%, partial - in 21%, minimal - in 47.4% of patients. In the second group, these values were 47.4%, 36.8% and 15.8%, respectively. In the first group, no signs of venous outflow disorders were observed in 31.6% of patients, mild disorders - in 15.8%, moderate disorders - in 31.6%, severe - in 21% of patients. In the second group, these values were 47.4%, 31.6%, 10.5% and 10.5%, respectively. CONCLUSION: Thrombolysis with alteplase is safer and more effective compared to urokinase.
Asunto(s)
Activador de Plasminógeno de Tipo Uroquinasa , Trombosis de la Vena , Humanos , Activador de Plasminógeno de Tipo Uroquinasa/efectos adversos , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Activador de Tejido Plasminógeno/efectos adversos , Terapia Trombolítica/efectos adversos , Catéteres/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: To study the efficacy and safety of venous stenting and long-term anticoagulation with inhibitors of blood clotting factor XA in the treatment of total and subtotal deep vein thrombosis. MATERIAL AND METHODS: We analyzed 60 patients with total and subtotal deep vein thrombosis divided into 2 comparable groups by 30 people. Patients of the first group underwent regional catheter thrombolysis and percutaneous mechanical thrombectomy. The same endovascular treatment supplemented by venous stenting was performed in the second group. In the first group, rivaroxaban was prescribed before, during and for 6 months after surgery; apixaban was used in the second group. Complications of endovascular and anticoagulant therapy were recorded. After 12 months, control ultrasound and clinical examination of patients was performed to analyze recanalization of deep veins and severity of venous outflow disorders. Recanalization of veins was evaluated as follows: less than 50% - minimal, 50-99% - partial, 100% - complete. RESULTS: In the first group, complete and partial recanalization of veins was found in 63.3 and 36.7% of patients, respectively. In the second group, these values were 93.3 and 6.7%, respectively. In the first group, venous outflow disorders were absent in 56.7%, mild violations presented in 36.6%, moderate violations - in 6.7% of patients. In the second group, venous outflow was normal in 93.3% of patients, and mild disorders presented in 6.7% of patients. Hemorrhagic complications developed in 8 (13.3%) patients, equally in both groups.
Asunto(s)
Trombosis de la Vena , Humanos , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Venas , Stents/efectos adversos , Trombectomía/efectos adversos , Anticoagulantes/efectos adversos , Resultado del Tratamiento , Terapia Trombolítica/efectos adversosRESUMEN
OBJECTIVE: To study the efficacy and safety of percutaneous mechanical thrombectomy and long-term anticoagulation with rivaroxaban for proximal deep vein thrombosis. MATERIAL AND METHODS: We analyzed the effectiveness of treatment in 60 patients with proximal deep vein thrombosis divided into 2 homogeneous groups by 30 people. Standard therapy was performed in the first group, therapy with percutaneous mechanical thrombectomy was applied in the second group. Patients received rivaroxaban in preoperative, perioperative and 6-month postoperative period. We considered complications of endovascular treatment and anticoagulation. Ultrasound and clinical examination were carried out after 12 months to analyze restoration of deep vein patency and venous outflow disorders. Recovery of vein lumen was assessed as follows: <50% - minimal, 50-99% - partial, 100% - complete. RESULTS: Recurrent deep vein thrombosis was found in 2 (6.7%) patients of the second group. Hemorrhagic complications following rivaroxaban therapy occurred in 8 (13.3%) patients (equally in both groups). In the first group, complete restoration of vein lumen was found in 16.7% of patients, partial recovery - in 40%, minimal recovery - in 43.3% of patients. In the second group, these values were 16.7%, 60% and 23.3%, respectively. Severe venous outflow impairment developed in 43.3% of patients in the first group and 23.3% of patients in the second group. Moderate impairment occurred in 30% and 20% of patients, mild disorders - in 10% and 40% of patients, respectively. CONCLUSION: Percutaneous mechanical thrombectomy on the background of long-term anticoagulation with rivoroxaban improves treatment outcomes in patients with proximal deep vein thrombosis.
Asunto(s)
Rivaroxabán , Trombosis de la Vena , Anticoagulantes/efectos adversos , Humanos , Estudios Retrospectivos , Rivaroxabán/efectos adversos , Trombectomía/efectos adversos , Terapia Trombolítica , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugíaRESUMEN
Presented in this article is a clinical case report regarding treatment of a patient with deep vein thrombosis complicated by venous gangrene having developed 10 days after the onset of the disease. Conservative therapy (infusion of colloids and crystalloids, anticoagulants, agents improving microcirculation, venotonics, nonsteroidal anti-inflammatory drugs, elevated position of the limb) made it possible to stabilize the patient's condition, but not improving haemodynamics of the affected limb. A decision was made to use endovascular techniques. Treatment was carried out in three stages. The first stage during 48 hours consisted in regional catheter thrombolysis with urokinase, exerting a minimal clinical effect. The second stage was percutaneous mechanical thrombectomy after which the diameter of thrombosed veins became free by half, with the beginning of disease regression. The third stage consisted in venous stenting of residual stenosis of the iliac vein, resulting in normalization of the venous outflow from the affected limb. A conclusion was drawn on feasibility of combined use of regional thrombolysis, percutaneous mechanical thrombectomy, and venous stenting in treatment of venous gangrene.
Asunto(s)
Gangrena , Trombosis de la Vena , Gangrena/diagnóstico , Gangrena/etiología , Humanos , Vena Ilíaca , Stents , Trombectomía , Terapia Trombolítica , Resultado del Tratamiento , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/terapiaRESUMEN
PURPOSE: This study was undertaken to investigate efficacy of apixaban in prevention of haemorrhagic complications during treatment of proximal thromboses of deep veins of the lower extremities using endovascular techniques. PATIENTS AND METHODS: We retrospectively studied the results of treating a total of 50 patients presenting with deep vein thromboses at late stages of the pathological process. The patients were subdivided into 2 statistically homogeneous groups. Group One was composed of 30 patients undergoing treatment consisting in a combination of catheter-guided thrombolysis with urokinase and percutaneous mechanical thrombectomy, with rivaroxaban used for prolonged anticoagulation therapy. Group Two comprised 20 patients subjected to similar endovascular treatment with additional venous stenting. Prolonged 6-month anticoagulation therapy was carried out with apixaban. The results of treatment were assessed after 12 months by means of control ultrasonographic and clinical examination in order to determine the degree of restoration of the lumen of deep veins and severity of venous outflow impairments. RESULTS: After 1 year, in Group One patients there was no evidence of impaired venous outflow in 40% of patients, with a mild degree revealed in 40%, moderate degree in 13.3%, and severe degree in 6.7% of patients. In Group Two patients, there were no symptoms of venous insufficiency in 83.4%, with a mild degree revealed in 16.6%. Neither moderate nor severe impairments of venous outflow were observed. In Group One, manifestations of haemorrhagic syndrome on the background of taking rivaroxaban were noted to occur in 10% of patients and in Group Two on the background of taking apixaban also in 10% of patients. CONCLUSION: The use of apixaban in patients with proximal thromboses of deep veins of lower limbs on the background of treatment by endovascular techniques proved effective and safe.