Perkutana aspiracijska trombektomija u Paget-Schroetterovu sindromu – prikaz bolesnika
| Autor: | Ana Antonić, Koraljka Benko, Kristina Uglešić, Tin Nadarević, Vjekoslav Tomulić |
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| Jazyk: | angličtina |
| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Cardiologia Croatica Volume 18 Issue 7-8 |
| ISSN: | 1848-5448 1848-543X |
| Popis: | SUMMARY We report the case of a younger, physically active patient who presented at the emergency department with swelling, pain, and bluish discoloration of the left arm, with clinical examination identifying effort-induced deep vein thrombosis of the arm (Paget-Schroetter syndrome). After unsuccessful medication treatment with a therapy dose of low-molecular-weight heparin, the patient was treated with an endovascular procedure – percutaneous aspiration thrombectomy. The procedure was successful, with the establishment of peripheral flow through the subclavian, axillary, and cephalic vein despite some thrombotic masses remaining. Before discharge, the patient was placed on peroral anticoagulation treatment with rivaroxaban. Additional imaging was performed during treatment of the superior thoracic aperture, confirming the diagnosis. Expanded laboratory testing showed values within normal limits. Follow-up showed regression of the symptoms. Color Doppler ultrasound and clinical examination verified maintenance of peripheral flow through the affected veins, with residual small thrombi and the development of collaterals. The patient was subsequently considered for decompression therapy by removing the first rib as a permanent solution for the symptoms. SAŽETAK Prikazujemo slučaj mlađeg, fizički aktivnog bolesnika u kojeg su se pri hitnom prijemu manifestirali oteklina, bolnost i plavičasta diskoloracija lijeve ruke te mu je obradom ustanovljena naporom inducirana duboka venska tromboza ruke (Paget-Schroetterov sindrom). Nakon neuspješna medikamentnog liječenja terapijskom dozom niskomolekularnog heparina liječen je endovaskularnim zahvatom – perkutanom aspiracijskom trombektomijom. Postupak je protekao uredno uz uspostavu rubnog protoka kroz potključnu, pazušnu te cefaličnu venu usprkos ostatnim trombotskim masama. Prije otpusta uvedena je peroralna antikoagulantna terapija rivaroksabanom. U sklopu obrade sindroma gornje torakalne aperture provedena je dodatna slikovna obrada kojom je dijagnoza potvrđena. Nalazi proširene laboratorijske obrade bili su u granicama normale. Na kontrolnim pregledima praćena je regresija tegoba. Color Doppler ultrazvukom te klinički verificiran je i dalje održan rubni protok kroz zahvaćene vene uz rezidualne male trombe te razvoj kolaterala. U bolesnika se razmatra dekompresijsko liječenje resekcijom prvog rebra kao konačno rješenje uzroka tegoba. |
| Databáze: | OpenAIRE |
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