Case of effective endovascular treatment of venous gangrene

Sukovatykh B.S.1, Sereditskiy A.V.2, Azarov A.M.2, MuradyanV.F.2, Sukovatykh M.B.1, Lapinas A.A.2

¹ Department of General Surgery, Kursk State Medical University, Kursk,
² Department of Endovascular Surgery, Orel Regional Clinical Hospital, Orel, Russia

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.

KEY WORDS: deep vein thrombosis, venous gangrene, regional catheter-directed thrombolysis, percutaneous mechanical thrombectomy, venous stenting.

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