Trombo flutuante em veias profundas de membro inferior e síndrome de May-Thurner: relato de caso
Free-floating thrombus in lower limb deep veins and May-Thurner syndrome: case report
Helio Bergantini Neto; Selma Regina de Oliveira Raymundo; Daniel Gustavo Miquelin; Gleison Juliano da Silva Russeff; Desirée Francini del Frari Silva; Gabriela Leopoldino da Silva; Amabile Oficiati de Carnevale Galeti; Matheus Pietraroia dos Santos
Free-floating thrombus in the deep venous system has a high potential to cause pulmonary embolization. It can also be found in patients with superficial venous thrombosis (SVT) that extends to a deep vein. There are still no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments with vena cava filter implants, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. We present the case of a patient with extensive deep venous thrombosis affecting the iliofemoral-popliteal territory with a floating thrombus extending from the left common iliac vein to the inferior vena cava. Treatment was performed with fibrinolytic therapy delivered with a multiperforated catheter, supplemented with anticoagulation with heparin and daily control angiography. At the end of the treatment, a significant stenosis was identified in the left common iliac vein, and angioplasty was performed with stenting.
1 Gillum RF. Pulmonary embolism and thrombophlebitis in the United States, 1970-1985. Am Heart J. 1987;114(5):1262-4.
2 Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med. 2010;38(4, Suppl):S495-501.
3 White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23, Suppl 1):I4-8. PMid:12814979.
4 Moser KM, LeMoine JR. Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med. 1981;94(4 pt 1):439-44.
5 Norris CS, Greenfield LJ, Herrmann JB. Free-floating iliofemoral thrombus. A risk of pulmonary embolism. Arch Surg. 1985;120(7):806-8.
6 Casian D, Gutsu E, Culiuc V. Extraluminal venous interruption for free-floating thrombus in the deep veins of lower limbs. Chirurgia (Bucur). 2010;105(3):361-4. PMid:20726302.
7 Jorgensen JO, Hanel KC, Morgan AM, Hunt JM. The incidence of deep venous thrombosis in patients with superficial thrombophlebitis of lower limbs. J Vasc Surg. 1993;18(1):70-3.
8 Araujo WJB, Timi JRR, Erzinger FL, Caron FC. Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literature. J Vasc Bras. 2016;15(2):147-52.
9 Voet D, Afschrift M. Floating thrombi: diagnosis and follow-up by duplex ultrasound. Br J Radiol. 1991;64(767):1010-4.
10 Yamaki T, Konoeda H, Osada A, Hasegawa Y, Sakurai H. Prevalence and clinical outcome of free-floating thrombus formation in lower extremity deep veins. J Vasc Surg Venous Lymphat Disord. 2015;3(1):121-2.
11 Huegel U, Surbek D, Mosimann B, Kucher N. Radiation-and contrast medium-free catheter-directed thrombolysis for early pregnancy-related massive iliocaval deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2019;7(1):122-5.
12 Ehringer H, Minar E. Therapy of acute ilio-femoral vein thrombosis. Internist (Berl). 1987;28(5):317-35. PMid:3301720.
13 Caggiati A, Allegra C. Historical introduction. In: Bergan JJ, editor. The vein book. Oxford: Elsevier; 2007. p. 1-14.
14 Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2016;11(11):CD002783. PMid:27830895.
15 Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-52. PMid:26867832.
16 Xue GH, Huang XZ, Ye M, et al. Catheter-directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis: outcome and follow-up. Ann Vasc Surg. 2014;28(4):957-63.