Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200075
Jornal Vascular Brasileiro
Case Report

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

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Resumo

Resumo: O trombo flutuante no sistema venoso profundo manifesta elevado potencial de embolização pulmonar. Pode também ser encontrado em pacientes com trombose venosa superficial (TVS) com extensão para uma veia profunda. Os tratamentos descritos na literatura, ainda sem critérios definidos, variam desde anticoagulação e tratamentos fibrinolíticos com implantes de filtros de veia cava, trombectomias abertas ou com dispositivos endovasculares até condutas mais invasivas como a interrupção cirúrgica com ligadura do sistema venoso. Apresentamos o caso de uma paciente com trombose venosa profunda extensa, acometendo o território ilíaco-fêmoro-poplíteo com um trombo flutuante estendendo-se da veia ilíaca comum esquerda até a veia cava inferior. O tratamento foi realizado com terapia fibrinolítica com um cateter multiperfurado, associado a anticoagulação com heparina e a controles angiográficos diários. Ao final do tratamento, foi identificada uma estenose significativa na veia ilíaca comum esquerda, sendo realizada angioplastia com implante de stent.

Palavras-chave

trombose venosa, anticoagulantes, fibrinólise, embolia pulmonar

Abstract

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.

Keywords

venous thrombosis; anticoagulants, fibrinolysis; pulmonary embolism.

References

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Submitted date:
05/18/2020

Accepted date:
07/06/2020

5faecc930e88253e28134908 jvb Articles

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