[Current role of the surgeon in the treatment of venous thromboembolism].
The most frequent complications of deep venous thrombosis (DVT) are post-thrombotic syndrome (PTS) and pulmonary embolism (PE); the main purpose of DVT therapy is to prevent their onset. A range of treatment is now available, including physical, medical and surgical forms. Physical: elastic compression mobilization postural therapy. Medical: anticoagulants (heparin, LMW heparins, oral anticoagulants), thrombolytic agents. Surgical: if DVT is diagnosed at an early stage, anticoagulant treatment may be accompanied by attempted surgical deobstruction, above all if DVT is localised at the popliteal and femoral confluents (greater risk of evolution towards severe "ischemic" forms potential cause of venous gangrene). These treatments include locoregional endogenous thrombolysis followed after phlebography, by surgical thrombectomy in the event of thrombotic residue, enabling the possible embolization of the pulmonary district using a caval filter. The combined medical and surgical approach reduces the long-term incidence of PTS. Temporary caval filters are also available. In short, a modern approach to the clinical problem of DVT now takes the form of early diagnosis and combined thrombolysis-surgery, which appears to be the most appropriate choice, ensuring the best form of venous functional recovery. However, this requires hospitalization in specialist units and multidisciplinary skills (hematological, medical, radiological and surgical) to ensure the best results.
Dipartimento di Scienze Chirurgiche ed Oncologiche, Università degli Studi, Palermo.
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Florena
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Bajardi
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D011379:Prognosis; D011655:Pulmonary Embolism / Q000517:prevention & control; D017131:Thrombectomy; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D013997:Time Factors; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin