[Signs of high embolic risk in iliocaval floating thrombi].

Q4 Medicine
A V Bocharov, K A Savostyanov, A K Tsagaeva, L V Popov, I V Olisaev, S V Alborov, F A Tuaev
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引用次数: 0

Abstract

Objective: To analyze the ultrasound characteristics of iliocaval floating thrombi in patients with deep vein thrombosis regarding embolic risk.

Material and methods: The study included 221 patients with deep vein thrombosis and iliocaval floating component. According to indications, all patients underwent implantation of infrarenal vena cava filter and received adequate anticoagulation. We analyzed the following parameters: length of floating clot, clot neck-to-stem ratio (minimum diameter of floating thrombus and diameter of clot attachment to occlusive thrombus), ratio of diameter of the clot neck to the widest part of the floating thrombus, as well as presence of large lateral inflow (internal iliac vein) near floating thrombus. Vena cava filter area was assessed regarding emboli. Ultrasound examinations were performed daily until primary endpoint (floating clot detachment or attachment to venous wall). The embolism group included 23 patients with clot detachment and cava filter embolism. The fixation group included 198 patients without cava filter embolism and floating thrombus attached to venous wall.

Results: The risk of floating thrombus detachment increases by 2.49 times in patients with floating clot 70-79 mm [odds ratio (OR) 2.49; 95% confidence interval (CI) (1.2; 5.16); p=0.02] and 4.8 times in case of length >80 mm [OR 4.8; 95% CI (1.34; 17.19); p=0.03]. Minimum diameter of floating clot divided into diameter of clot attachment <30% increases the risk of detachment by 2.81 times [OR 2.81; 95% CI (1.44; 5.48); p=0.01]. Large lateral tributary near the neck of the floating thrombus increases the risk of detachment by 1.99 times [OR 1.99; 95% CI (1.1; 3.71); p=0.04].

Conclusion: There are certain risk factors in patients with deep vein thrombosis, iliocaval floating thrombus and no contraindications to anticoagulation (clot length >70 mm, minimum diameter of floating clot divided into diameter of clot attachment <30% and large lateral tributary near the neck of the thrombus). These ones should probably be classified as a group with extremely high risk of fatal pulmonary embolism and need for endovascular prophylaxis of venous thromboembolic complications (cava filter implantation) in addition to anticoagulation.

[髂腔漂浮血栓的高栓塞风险的迹象]。
目的:分析深静脉血栓患者髂腔漂浮血栓的超声特征及其栓塞危险性。材料与方法:研究对象为深静脉血栓形成伴髂腔漂浮成分的221例患者。根据适应症,所有患者均行肾下腔静脉滤器植入,并给予充分的抗凝治疗。我们分析了以下参数:漂浮血栓的长度,血栓颈干比(漂浮血栓的最小直径和粘附在闭塞血栓上的血栓的直径),血栓颈直径与漂浮血栓最宽部分的比,以及漂浮血栓附近是否存在大的侧流(髂内静脉)。评估腔静脉滤过面积是否有栓塞。每天进行超声检查,直到主要终点(浮凝块脱离或附着于静脉壁)。栓塞组包括23例血栓脱离和腔静脉滤过器栓塞患者。固定组198例,无腔静脉滤过器栓塞及静脉壁漂浮血栓。结果:漂浮血栓70-79 mm患者发生漂浮血栓脱离的风险增加2.49倍[优势比(OR) 2.49;95%置信区间(CI) (1.2;5.16);p=0.02],长度>为80mm时为4.8倍[OR 4.8;95% ci (1.34;17.19);p = 0.03)。最小浮凝块直径分为血栓附着直径p=0.01]。靠近漂浮血栓颈部的大外侧分支使脱离的风险增加1.99倍[OR 1.99;95% ci (1.1;3.71);p = 0.04)。结论:深静脉血栓形成患者存在一定的危险因素,髂腔漂浮血栓无抗凝禁忌症(血栓长度> ~ 70 mm,最小漂浮血栓直径分为血栓附着直径)
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来源期刊
Khirurgiya
Khirurgiya Medicine-Medicine (all)
CiteScore
0.70
自引率
0.00%
发文量
161
期刊介绍: Хирургия отдельных областей сердце, сосуды легкие пищевод молочная железа желудок и двенадцатиперстная кишка кишечник желчевыводящие пути печень
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