Surgical Prevention of Thromboembolic Complications in Transfascial Thrombosis
Abstract
The aim. To evaluate the effectiveness of surgical methods of prevention of venous thromboembolic complications in transfascial thrombosis of the lower extremities.
Materials and methods. The paper analyzes the results of examination and surgical or conservative treatment of 417 patients with transfascial thrombosis treated at the Vascular Surgery Department of the Zakarpattia Regional Clinical Hospital named after A. Novak from 1995 to March 2020 and at the Surgical Department of the Central City Clinical Hospital of Uzhhorod from September 2020 to September 2022. The main (I) group consisted of 349 (83.7%) patients who were operated for transfascial thrombosis. The control (II) group consisted of 68 (16.3%) patients with transfascial thrombosis who received conservative treatment.
Results. In case of acute varicothrombophlebitis complicated by transfascial thrombosis, the scope of surgery should be expanded in order to surgically prevent thromboembolism of the pulmonary artery. All the patients with transfascial thrombosis were treated as for deep vein thrombosis. The approach to the removal of the small saphenous vein should be differentiated depending on the extent of thrombotic occlusion and the confluence of the sural veins. Surgical treatment of patients with transfascial thrombosis made it possible to prevent recurrence of the thrombotic process in the superficial and deep veins of the lower extremities, thromboembolism of the pulmonary artery, while with conservative treatment their frequency was 5.1%, 3.4% and 3.4%, respectively. Active surgical tactics in patients of the I group made it possible to reduce the frequency of manifestations of decompensated chronic venous insufficiency from 27.1% to 7.0%, and manifestations of postthrombotic syndrome in the deep veins of the lower extremities from 100% to 3.7%.
Conclusions. Implementation of operative treatment of acute varicothrombophlebitis complicated by transfascial thrombosis allows to effectively prevent venous thromboembolic complications, eliminate manifestations of chronic venous insufficiency and prevent the development of post-thrombotic changes in superficial and deep veins.
References
- Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450-7. https://doi.org/10.1111/j.1538-7836.2010.04044.x
- Caprini JA. Thrombotic Risk Assessment: A Hybrid Approach. In: Bergan JJ, ditor. The Vein Book. London: Elsevier Academic Press; 2007. p. 359-67. https://doi.org/10.1016/B978-012369515-4/50044-2
- Usenko OYu, Chernukha LM, Horbovets VS, Hubka VO, Hudz IM, Hupalo YuM, et al. [Chronic diseases of veins of the lower extremities and pelvis. Clinical and practical recommendations]. Klinichna khirurhiia. 2022;89(1-2):11-41. Ukrainian. https://doi.org/10.26779/2522-1396.2022.1-2.11
- De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184-267. https://doi.org/10.1016/j.ejvs.2021.12.024. Erratum in: Eur J Vasc Endovasc Surg. 2022;64(2-3):284-285.
- Décousus H, Bertoletti L, Frappé P. Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat? J Thromb Haemost. 2015;13 Suppl 1:S230-7. https://doi.org/10.1111/jth.12925
- Di Minno MN, Ambrosino P, Ambrosini F, Tremoli E, Di Minno G, Dentali F. Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost. 2016;14(5):964-72. https://doi.org/10.1111/jth.13279
- Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2018;2(2):CD004982. https://doi.org/10.1002/14651858.cd004982.pub6
- Eichinger S, Heinze G, Jandeck LM, Kyrle PA. Risk Assessment of Recurrence in Patients With Unprovoked Deep Vein Thrombosis or Pulmonary Embolism: The Vienna Prediction Model. Circulation. 2010;121(14):1630-6. https://doi.org/10.1161/CIRCULATIONAHA.109.925214
- Golamari RR, Roy SG, Zheng S, Alvarez M, Ramireddy K, Pedersen C. Can Pulmonary Embolism Severity Index (PESI) Score Predict Readmission Rates in Patients With Pulmonary Embolism? [abstract]. Circulation. 2019;140:A15537.
- Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of Pulmonary Embolism in the Emergency Department: The Revised Geneva Score. Ann Intern Med. 2006;144(3):165-71. https://doi.org/10.7326/0003-4819-144-3-200602070-00004
- Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015;350:h2039. https://doi.org/10.1136/bmj.h2039
- Popovich YaM. Profilaktyka tromboembolii lehenevoi arterii na tli transfastsialnoho trombozu [Profilaxis of pulmonary embolism with transfascial thrombosis]. Sertse i sudyny. 2018;(1(61)):58-64. Ukrainian. https://doi.org/10.30978/HV2018158
- Rusyn VI, Korsak VV, Popovych YaM, Boiko SO, Lurin IA, Boldizhar PO, et al. Khirurhichne likuvannia tromboziv nyzhnoi porozhnystoi veny [Surgical treatment of inferior vena cava thrombosis: a monograph]. Uzhhorod: Karpaty; 2017. Ukrainian.
- Scott G, Mahdi AJ, Alikhan R. Superficial vein thrombosis: a current approach to management. Br J Haematol. 2015;168(5):639-45. https://doi.org/10.1111/bjh.13255
- Tait C, Baglin T, Watson H, Laffan M, Makris M, Perry D, et al.; British Committee for Standards in Haematology. Guidelines on the investigation and management of venous thrombosis at unusual sites. Br J Haematol. 2012;159(1):28-38. https://doi.org/10.1111/j.1365-2141.2012.09249.x
- Boiko VN, Bereznytskyi YaS, Venger IK, Hryn VK, Herasymenko SI, Hlumcher FC, et al. Venoznyi tromboembolizm: diahnostyka, likuvannia, profilaktyka. Mizhdystsyplinarni klinichni rekomendatsii [Venous thromboembolism: diagnosis, treatment, prevention. Interdisciplinary clinical recommendations]. Kyiv; 2013. Ukrainian.
- Boiko VN, Bereznytskyi YaS, Venger IK, Hryn VK, Herasymenko SI, Hlumcher FC, et al. Venoznyi tromboembolizm: diahnostyka, likuvannia, profilaktyka. Mizhdystsyplinarni klinichni rekomendatsii [Venous thromboembolism: diagnosis, treatment, prevention. Interdisciplinary clinical recommendations]. Kyiv; 2011. Ukrainian.
- Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Haemost. 2007;5(Suppl 1):41-50. https://doi.org/10.1111/j.1538-7836.2007.02493.x
- Werth S, Bauersachs R, Gerlach H, Rabe E, Schellong S, Beyer-Westendorf J. Superficial vein thrombosis treated for 45 days with rivaroxaban versus fondaparinux: rationale and design of the SURPRISE trial. J Thromb Thrombolysis. 2016;42(2):197-204. https://doi.org/10.1007/s11239-016-1354-3
