[Thrombectomy or thrombolysis in the treatment of proximal phlebitis. Functional long term results].
MATERIALS AND METHODS Between 1981 and 1985, 78 iliocaval thrombi were treated by aggressive therapy: 52 surgical thrombectomies were performed by a femoral approach associated, depending on the case, with a caval approach; and 26 iliofemoral thrombi were lysed according to a protocol in which urokinase and plasminogen were used over a 48-h period. Subsequent functional evaluation was based on clinical scoring (0 to 9 points) taking into account functional impairment, edema and trophic disorders. Patency of trunks and the deep valvular state were assessed by Doppler examination and plethysmography. RESULTS In the surgical group, 3 early deaths occurred, only one of which could be attributed to an embolic course. Six weeks after surgery the rate of recurrence of iliac thrombosis was 50% (25% postoperative + 25% secondary). Beyond this period, there were no recurrences of thrombosis. There was a direct, statistically significant relation between the degree of iliac patency and the realization of an ideal thrombectomy on a nonadherent fresh clot. The functional results, assessed after four and a half years of follow-up, are satisfactory (score less than 3) in 80% of patients. The poor results with venous claudication or varicose ulcer all occurred in the case of massive persistent thrombi of the femoral confluence. Valve lesions were signaled in 46% of patients by a massive backflow in orthostatism. In the medical group, a major hemorrhagic complication occurred under urokinase therapy in 11% of patients, including one for whom it was fatal. Sixty percent of patients showed immediate radiological improvement allowing partial or total freeing of a venous confluence. The functional results after 4 years of follow-up were nondisabling in 85% of patients. No leg ulcers were detected. Late iliac patency was low (26%), whereas at the femoral level almost all of the thrombi which remained after lysis became patent again spontaneously. Valve failure was found in 37% of patients. Both groups had very similar late functional results despite rather different anatomical conditions. The iliac patency rate was higher in the surgical group (50% vs 26%), but plethysmographic study showed that in case of therapeutic failure devalvulation was greater after surgery (46% vs 37%).
Frisch
N
N
Chirurgie B., CHRU Hôpital Central, Nancy.
Fieve
G
G
Schmidt
C
C
Laprevotte
M C
MC
Larcan
A
A
Frisch
R
R
D005268:Femoral Vein; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007084:Iliac Vein; D010958:Plasminogen / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000188:drug therapy / Q000601:surgery*; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use; D014654:Vascular Patency; D014684:Venae Cavae
D010958:Plasminogen; D014568:Urokinase-Type Plasminogen Activator
Thrombectomie ou thrombolyse dans le traitement des phlébites proximales. Résultats fonctionnels à long terme.