Fuentes-del-Toro S, Enríquez-Vega E, Ayala-López EA

Language: Spanish
References: 12
Page: 45-47
PDF size: 38.38 Kb.

ABSTRACT

Venous thrombectomy is indicated to remove ileofemoral or inferior vein thrombi in order to prevent pulmonary thromboembolism (PT) and to reduce the severity of the post-thrombotic syndrome. This surgical procedure is also indicated in patients with a contraindication for direct thrombolysis. It should be done during the first 72 hours after thrombosis occurred. It should be considered in the treatment of extended ileofemoral thrombosis with an imminent lost of the leg and it is commonly reserved for young patients. Early mortality is 1%. Cumulated efficacy is around 75% alter four years; if the thrombus is not adherent to the vessel wall, efficacy reaches 92% but it falls to 45% if it is adherent. Early rethrombosis is a possibility although other complications may exist. Surgical embolectomy is performed only in a few medical centers in Mexico. Its mortality rate is very high (20% to 50%). It is indicated if there is a sub-total or total obstruction of the main pulmonary artery or in the case of obstruction of one of its main branches without chronic pulmonary arterial hypertension. Surgical interruption and use of inferior vena cava filters (IVCF) may offer thromboprophylaxis against PT. The most clinically used filter is the Greenfield filter. Desirable characteristics of IVCF are: to be able to trap the embolus without affecting the blood flow; it should not generate thrombogenic material; it should be easily collocated by a percutaneous procedure; it may allow a firm fixation without injury of the vessel wall in order to avoid migration; it should be made of a non-ferromagnetic material: it should be retrieved without injuring the vessel wall. Because permanent IVCF may induce some long-term complications, temporal filters are quite desirable since they can avoid some of the long-term potential sequelae.

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