"Rational use of an additional arsenal in the treatment of acute venous thrombosis", Moscow, 27.09.2017.
- Author: Semenov Artem Yuryevich
- Category: News
- Views: 817
27 September 2017 in the conference hall of the hotel "Raikin PLAZA Hotel" held a scientific and practical conference from the series "School of thrombosis" on the topic "Rational use of an additional arsenal in the treatment of acute venous thrombosis."
The employee of the phlebology center "MIFTS" Malakhov Aleksey Mikhailovich took part in the conference.
Presidium of the scientific-practical conference
The event was opened by Doctor of Medicine, Professor Viktor Evgenievich Barinov (Moscow). The lecture presented an overview of modern methods of treatment of acute venous thrombosis.
Reported by Professor, MD. Barinov V.E. (Moscow)
This pathology remains a difficult problem for specialists all over the world. In the overwhelming majority of cases, standardized anticoagulation therapy is used for treatment (treatment with drugs that depress the blood coagulating system). Nevertheless, with this approach, signs of chronic venous insufficiency develop for 90% of patients in five years, venous lameness develops in 40%, and venous ulcer in 15% of cases. The main factor in the development of pathological symptoms is residual venous obstruction (residual vasoconstriction). The smaller it is, the more favorable the subsequent course of the process. If the vein 50% and more is obstructed, half of the patients during 6-years will have a recurrence of thrombosis, and if the vessel is more than 50%, only 5% is threatened with retrombosis. Even the creation of more sophisticated and easy-to-use medicinal preparations could not radically affect the state of the matter. Doctors turned to the surgical treatment of venous thrombosis in order to reduce residual obstruction and subsequent complications. At the moment, all interventions can be divided into two large groups: open and endovascular (intravascular) thromboextraction. Open thromboextraction - mechanical removal of a clot from the venous channel with the help of a Fogarty catheter (the most common is AJ Comerota surgery). Endovascular techniques have received a certain acceleration vector over the last 20 years. At the moment they are represented by mechanical, pharmacological, pharmaco-mechanical and aspiration thromboextraction. The most proven is the pharmacological (catheter-controlled thrombolysis) and pharmaco-mechanical thromboextraction. Due to the relatively low cost, simplicity of execution, the technique of catheter thrombolysis has become more widespread. The disadvantages of this method include increased risk of bleeding, longer duration of the procedure (up to 72 hours or more), a high dependence of the effect on the duration of thrombosis, frequent phlebographic control (every 12 hours). The principle of pharmaco-mechanical thromboextraction techniques is based on the combination of mechanical (ultrasound in the case of EKOS) thrombus removal with local delivery of drugs destroying the thrombus. The tangible advantages of these technologies are a reduction in the risk of bleeding and the duration of the procedure. To a minus it is possible to carry cost of the equipment, at similar efficiency with a catheter thrombolysis.
Ph.D. Kirill Viktorovich Lobastov (Moscow) continued the theme of endovascular methods of treatment of acute venous thrombosis.
Reports by Dr. Lobastov K.V. (Moscow)
He presented a meta-analysis of a large number of studies in recent years, including Cochran's (have the greatest authority in the scientific community) comparison of standard anticoagulant therapy with endovascular thrombolysis techniques. In the results of this work, we can summarize the following, using thrombolysis, we prevent 20% early and 25% late post-thrombotic syndrome. Similarly, Dr. Lobastov elaborated on the economic component of the treatment issue. If you look a little broader, take into account the costs of long-term anticoagulant therapy, take into account aspects of patient disability, then even the maximum costs for endovascular methods are justified. In continuation of his report, Kirill presented a lecture on "Thrombosis and inflammation: the relationship and possibilities of correction." An integral part of the process of venous thrombosis is inflammation. In this context, in the prolonged therapy of venous thrombosis, the following drugs are of great interest: sulodexide (Wessel duet f) and bioflavonoids (Detralex, Fleobodia).
Reported by Professor, MD. LA Laberko (Moscow)
MD, Professor Leonid Alexandrovich Laberko (Moscow) presented a message on the topic "Is Compression Therapy Needed in the Treatment of Acute Venous Thrombosis?" In his lecture, Leonid Alexandrovich described in detail the effects of elastic compression therapy, variable pneumocompression and electromyostimulation in the treatment of acute venous thrombosis.
Reported by Dr. Shebryakov V.V. (Moscow)
Vladimir Vladimirovich Shebryakov from Moscow in his report described the use of magnetic resonance imaging in the diagnosis of venous thrombosis. This technique has the following advantages: safety, informative, does not require special training of patients. In doing so, it allows you to clearly assess the level of thrombosis, the state of collateral blood flow. 3D MR-phlebography allows to model reconstructive and restorative operations on the veins of a particular patient.
Ph.D. Ilya Schastlivtsev (Moscow) demonstrated a master class on successful catheter-guided thrombolysis.
Reports Dr. Schastlivtsev IV
Treatment consisted in the installation of a removable cava filter (removed through 3 weeks), catheter thrombolysis with urokinase and concomitant anticoagulant therapy. This case is interesting for several reasons. 1) Acute thrombosis in the patient occurred in the postpartum period. 2) Transiently (temporarily) in a laboratory study, a lupus anticoagulant was revealed - a sign of an antiphospholipid syndrome. Long-term follow-up for 24 months showed complete absence of clinical symptoms and complaints. In subsequent studies, the tests returned to normal, the diagnosis of antiphospholipid syndrome is not confirmed.
Ph.D. Igor Nikolaevich Sonkin from St. Petersburg, who has the most extensive experience of catheter-guided thrombolysis in Russia, presented two reports at once.
Reported by a vascular surgeon Sonkin IN (St. Petersburg)
In the first part of his report, Igor Nikolaevich exhaustively described the criteria for selecting patients for this procedure, detailing the contraindications for this intervention. He also presented algorithms for the treatment of deep vein thrombosis of lower and upper extremities, thrombophlebitis of superficial veins of lower limbs. In the second part of the report, Dr. Sonkin uncovered the nuances of the technique of catheter-guided thrombolysis. Based on the global and domestic experience, the following conclusions can be drawn: this technique is safe and effective, fairly simple in execution, greatly improving the results of treatment of deep vein thrombosis.
After the speeches, the participants of the conference asked sharp and burning questions about the reports that were sounded.
Head of "CIF", Ph.D. Solomakhin AE asks a question
The scientific practical conference from the cycle "School of thrombosis" once again showed the importance of such events. She enriched the knowledge of surgeons, vascular surgeons and doctors of related specialties, shared her new experience in the treatment of acute venous thrombosis.