OMPARATIVE ANALYSIS OF METHODS FOR PREVENTION OF THROMBOEMBOLIC COMPLICATIONS IN THROMBOSIS OF DEEP VEINS OF THE LEGS (below the inguinal fold)
Keywords:
venous thrombosis, thromboembolic complications, surgical prevention, plication, ligation, floating thrombus.Abstract
Introduction. Infrainguinal deep vein thrombosis remains a significant challenge in modern vascular surgery, posing a serious threat of pulmonary embolism (PE) with potentially fatal outcomes. Floating thrombi have the highest embolic potential and require immediate decision-making regarding the optimal treatment strategy. Selecting an optimal strategy to prevent thromboembolic complications requires a differentiated approach based on assessment of thrombus characteristics and embolic potential.
Aim. To conduct a comparative analysis of the efficacy and safety of modern methods for the prevention of thromboembolic complications in infrainguinal deep vein thrombosis and to develop an optimal treatment algorithm based on thrombotic process characteristics.
Material and methods. A retrospective evaluation of treatment outcomes was performed in 379 patients with major lower extremity venous thrombosis treated at the Republican Research Center of Emergency Medicine between 2004 and 2023. The age range was 18 to 76 years. Patients were divided into three groups based on treatment strategy: Group I (n=133) – conservative anticoagulant therapy, Group II (n=94) – femoral vein plication, Group III (n=152) – femoral vein ligation distal to the deep femoral vein. Duplex ultrasound scanning was the primary diagnostic method.
Results and discussion. In Group I, stabilization was achieved in 64.7% of patients, with thrombosis progression in 35.3% of cases and PE developing in 3.8% of hospitalized patients. In Group II, postoperative complications occurred in 14.9%, including thrombosis progression (5.3%) and PE (6.4%). Group III demonstrated the lowest complication rate of 9.2%, with minimal PE (1.3%) and thrombosis progression (1.9%). Statistical analysis revealed significant advantages of ligation over plication (p < 0.05) across all major efficacy and safety parameters.
Conclusion. The developed differentiated algorithm for treatment selection significantly reduces thromboembolic complications. Femoral vein ligation is the most effective method for preventing embolic PE in patients with embolic thrombosis, with minimal complications and preservation of deep venous system function.
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