[Condition of the proximal portion of the thrombus in varicophlebitis of the great saphenous vein].

Autor:	Tsukanov IuT, Tsukanov AIu, Nikolaĭchuk AI
Jazyk:	ruština
Zdroj:	Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery [Angiol Sosud Khir] 2014; Vol. 20 (4), pp. 54-61.
Abstrakt:	Aim: To assess the state of the proximal portion of a thrombus of the great saphenous vein (GSV) in patients with varicophlebitis by means of duplex scanning of veins. Material and Methods: We examined a total of 40 patients with acute varicophlebitis of the GSV: 11 (27.5%) men and 29 (72.5%) women, the patients' average age amounted to 53.5 years (range 29-78). Duplex scanning (DS) was used to determine: localization and extent of thrombosis, the presence of a free portion, density and configuration of the contour of the proximal portion of the thrombus, proximal level of the inflammatory wall and paravasal fat. Results and Discussion: Inflammation was located on the crus in 12 (30%) patients, on the femur in 10 (25%), on the crus and femur in 18 (45%) patients. According to the findings of DS, of 28 (70%) patients with femoral inflammation the upper end of the thrombus was located in the lower third of the femur in 9 (22.5%) patients, in the middle third in 11 (27.5%) patients and in 8 (20%) patients in the upper third. In 29 (72.5%) patients the thrombus had no free part, eleven (27.5%) were found to have a floating portion 1.0-10 cm long (averagely 3.58 cm). The incidence of floating thrombi is determined by the diameter of the thrombosed vessel: in femoral localization the floating part was in 9 (22.5%) patients, in crural localization - in 2 (5%). A distinct edge of the proximal contour was present in 30 (75%) patients, diffuse contour in 10 (25%). In 8 (20%) patients the proximal portion of the thrombus by density did not differ from the patients' body. In 3 (7.5%) patients it approximated to density of blood. In the majority of cases (60%) the proximal portion was of cellular character with alternation of portions of various density. Thickness of the altered paravasal fat amounted to 7-20 mm (averagely 8.68 mm). The boarder of the thrombus in 56 (90%) patients located proximal to inflammation of the wall and paravasal fat by 4.0-60.0 cm (averagely 6.0 cm). This demonstrates that clinical symptoms induce phlebitis and paravasal cellulitis. Conclusion: Detailed examination of the proximal portion of the thrombus in patients with varicophlebitis of the GSV by means of DS makes it possible to accurately evaluate its condition: assessment of density and configuration provides a more detailed characterisation of the degree of maturity of the proximal portion of the thrombus. Thrombus density comparable with density of liquid blood in combination with its extended free portion may increase the risk of thrombus migration.
Databáze:	MEDLINE
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