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.