Journal «Angiology and Vascular Surgery» • 

2007 • VOLUME 13 • №1

PHLEBOTHROMBOSIS AND PULMONARY THROMBOEMBOLISM IN PATIENTS WITH THROMBOPHILIA

A.A. Karpenko, V.B. Gervaziev, Z.S. Barkagan, L.P. Tsyvkina
Chair of Hospital Surgery, Altai State Meaical University, Federal Center of Diagnosis and (treatment of Hemostatic Disorders, Central Research Laboratory, Altai State Medical University,
Barnaul, Russia

A study was made of the course of phlebothrombosis ana pulmonary thromboembolism in 54 patients with thrombophilia. Of these, 23 patients had factor la resistance to protein C, 15 presented with antiphospholipid syndrome, four with protein C deficit, one with protein S deficit, three with antithrombin III deficiency, and three patients with hyperhomocysteinemia. Five patients presented with the following combined forms of thrombophilia: thrombophilia due to protein C deficit and antiphospholipid syndrome; protein C deficit and hyperhomocysteinemia; protein C and antithrombin III deficit; factor Va resistance to protein C and hyperhomocysteinemia; antiphospholipid syndrome and hyperhomocysteinemia. Thrombosis of the inferior vena cava (IVC) was present in 52 and PTE in 27 patients. The recurrence of phlebothrombosis was recorded in 40 (76.9%), that of PTE in 12 (44.4%) patients. The time elapsed between disease exacerbations accounted for one month to nine years, the number of recurrences constituted two to 6. Initially, thrombosis in three patients was located in lower limb saphenous veins, in 18 in the tibial and femoral veins, in 29 in the femoral and iliac veins; two patients presented with femoroiliocaval phlebothrombosis. The recent control examination revealed thrombosis of the saphenous veins in two patients. In ten patients, thrombosis was located in the tibiofemoral segment, in 19 patients, it was discovered in the femoroiliac and in two cases, in the femoroiliocaval segment. During observation period, venous thrombosis in the previously intact lower limb developed in nine (16.7%) patients. Thrombosis of other vessels inclusive of the organ ones was present in 14 (25.9%) patients. Of these, seven patients had thrombosis of the arteries of the upper and lower limbs: in four cases, it was located in the system of the IVC and in two cases, in the mesenterial arteries; ischemic stroke was recorded in two cases, thrombosis of the portal vein in one, and myocardial infarction was also marked in one case.

In view of different hemostatic changes underlying the development of venous thromboses and PTE, we carried out differentiated therapy applying anticoagulants, platelet inhibitors, and transfusions of quickfrozed plasma. In acute femoroiliac and caval thromboses and PTE, 40 patients were provided implantation into the IVC of the cava filter "volan". After cava filter implantation 16 patients developed tnrombosis of the IVC. Embolism to the cava filter occurred in seven patients. In three cases, it terminated in occlusion of the IVC and in the remaining cases, in its recanalization. Over the period one to six years, occlusive thrombi of the IVC underwent recanalization in 11 patients. Analysis of the course of phiebothrombosis and PTE in patients with thrombophilia made it possible to define situations that require its goal-oriented search. It is demonstrated that it is advisable to implant the cava filter "volan" to the permanent position in thromboses of the femoral, iliac veins and of the IVC as well as in PTE.

KEY WORDS: thrombophilia, phlebothrombosis, pulmonary thromboembolism, cava filter.

P. 64

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