The use of antegrade venous thrombectomy with stenting for acute iliofemoral phlebothrombosis in a patient with post-thrombophlebitis disease

Abstract

Deep vein thrombosis is one of the most formidable conditions, which can subsequently cause pulmonary embolism and trigger the development of post-thrombophlebitic disease. The aim of our work was to evaluate the result of antegrade venous thrombectomy with stenting for acute iliofemoral phlebothrombosis in a patient with post-thrombophlebitic disease. Patient G., 33 years old, was admitted to the Department of Vascular Surgery of the City Clinical Hospital No. 7 of Kazan on January 1, 2021 on an emergency basis with complaints of severe swelling and pain in the right lower limb. Upon admission, the patient underwent ultrasound Doppler scanning of the veins of both lower extremities and X-ray tomography of the chest and abdominal cavities with contrast, according to which the diagnosis of acute iliofemoral phlebothrombosis on the right with thrombus flotation in the common iliac vein for 7 cm was made. According to vital indications, the surgery — transjugular thrombectomy from the iliofemoral segment using a proximal venous trap and subsequent implantation of a venous stent into the right common iliac vein — was performed. In the postoperative period, the patient received anticoagulant therapy. A day after the operation, a control ultrasound of the veins of the lower extremities and the inferior vena cava, X-ray tomography of the organs of the chest and abdominal cavity were performed. On the 5th day, the patient was discharged in a satisfactory condition under the supervision of a surgeon at the place of residence. Analysis of the results of surgical treatment of a patient with post-thrombophlebitic disease complicated by acute iliofemoral phlebothrombosis using antegrade venous thrombectomy with stenting showed that the patency of the stented iliac-femoral segment was maintained for up to 12 months. Thus, the proposed method of surgical treatment allows us to safely remove floating and occlusive thrombi from the iliocaval and femoral segments, implant stents, and thereby restore the patency of the segment, reducing the risk of possible repeated thrombosis, embolic and post-thrombophlebitic complications.

Keywords

floating thrombus / post-thrombophlebitic disease / iliofemoral thrombosis

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