Controverse privind riscul emboligen şi managementul optim al trombozei flotante a venelor profunde

Abstract

Background. It is suggested that free-floating form of deep venous thrombosis, especially that with proximal location, is associated with a higher rate of pulmonary embolism. The aim of current study was to estimate the risk of symptomatic embolism occurrence in pts with free-floating thrombus and to perform comparative analysis of early results of conservative versus surgical treatment in these cases. Methods. In a prospective investigation were included 69 pts (mean age: 56,82 years) with free-floating thrombi, defined by duplex ultrasound as presence of unattached to vein wall thrombotic apex with clearly visualized oscillatory movement. Fifty-two pts were treated surgically by means of venous plication (n=38; 73,07%) or ligation (n=14; 26,92%) asociated in some cases with partial thrombectomy (n=11), remaining 17 pts receiving anticoagulation treatment (adjusted doses of low molecular weight heparins with subsequent conversion to vitamin K antagonists). Results. Frecvency of simptomatic pulmonary embolism at admission or during hospitalization was 11,59%, while rate of diagnosed episodes of embolization rise to 18,84. The incidence of symptomatic pulmonary embolism in conservative group was 23,52% vs. 0% - recorded postoperatively (p<0,05; t-test), but rate of embolism-related death was 11,76% vs. 0%, respectively (p-NS; t-test). Conclusions. It is necessary to clarified and unified diagnostic criteria of free-floating thrombus. Until then clinical significance of free-floating thrombi cannot be objectively evaluated. Efficacy of both surgical and conservative treatment for prevention of massive pulmonary embolism in pts with free-floating thrombosis needs to be established on a larger clinical cases group.