Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)11410.18786/2072-0505-2015-43-82-89REVIEW ARTICLEОБЗОРENDOVASCULAR TREATMENT FOR DISORDERS OF THE VENOUS SYSTEMЭНДОВАСКУЛЯРНЫЕ МЕТОДЫ ЛЕЧЕНИЯ ПАТОЛОГИИ ВЕНОЗНОЙ СИСТЕМЫOsievA. G.ОсиевА. Г.
Russian Federation

Osiev Aleksandr G. – MD, PhD, Professor, Head of Department of Cardiovascular Surgery

* 61/2–9 Shchepkina ul.,Moscow, 129110,Russian Federation. Tel.: +7 (495) 681 35 09. E-mail: osiev_ag@mail.ru 

Осиев Александр Григорьевич – доктор медицинских наук, профессор, руководитель отделения хирургии сердца и сосудов

*129110, г. Москва, ул. Щепкина, 61/2–9, Российская Федерация. Тел.: +7 (495) 681 35 09. E-mail: osiev_ag@mail.ru 

osiev_ag@mail.ruVishnyakovaM. V.ВишняковаМ. В.
Russian Federation

Vishnyakova Mariya V. – MD, PhD, Head of Department of Roentgenology

Вишнякова Мария Валентиновна – доктор медицинских наук, руководитель рентгенологического отделения

osiev_ag@mail.ruGegenavaB. B.ГегенаваБ. Б.
Russian Federation

Gegenava Boris B. – Senior Research Fellow, Department of Сardiosurgery

Гегенава Борис Борисович – старший научный сотрудник кардиохирургического отделения

osiev_ag@mail.ruMoscow Regional Research and Clinical Institute (MONIKI)Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского151220154382891302201613022016Copyright ©; 2015, Osiev A.G., Vishnyakova M.V., Gegenava B.B.Copyright ©; 2015, Осиев А.Г., Вишнякова М.В., Гегенава Б.Б.2015Osiev A.G., Vishnyakova M.V., Gegenava B.B.Осиев А.Г., Вишнякова М.В., Гегенава Б.Б.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/114

The annual rate of deep vein thrombosis in general population is from 5 to 9 cases per 10 000, whereas for venous thromboembolism (deep vein thrombosis and pulmonary embolism taken together) amounts to 14 cases per 10 000. To improve longterm results of therapy for thrombosis of deep veins of the lower extremities, it is important to restore venous function and outflow. Anticoagulant therapy with low weight or non-fractionated heparin preparations remains the most widely used method of management. However, total or partial thrombosis resolution under anticoagulant treatment is achieved only in 4 and 14% of cases, respectively. Thrombolysis allows for early resorption of the thrombus by means of a minimally invasive procedure with lower risk of complication. After the venous flow is restored, the aim of treatment is to prevent damage to the venous valves, venous hypertension and repeated thrombosis with development of the post-thrombotic syndrome. Compared to anticoagulation, systemic thrombolysis has the benefit of more rapid clot resorption and less damage to the venous valve. One of its serious limitations is a high bleeding risk related to higher doses of the drug administered through a peripheral vein catheter. Therefore, selective intra-clot administration of thombolytics (direct catheter thrombolysis) has been suggested as an alternative. For more effective therapy with the use of lower doses of thrombolytics, the so called pharmaco-mechanical thrombectomy has been developed. Venous stenosis hindering the venous outflow is frequently seen after direct catheter or pharmaco-mechanical thrombolysis. Angioplasty with stent placement is recommended in the cases with residual venous abnormality after successful thrombolysis and thrombectomy. 

В общей популяции частота тромбоза глубоких вен нижних конечностей составляет от 5 до 9 случаев на 10 тыс. человек в год, а венозной тромбоэмболии (сочетание тромбоза глубоких вен и тромбоэмболии легочной артерии) – 14 случаев на 10 тыс. в год. Для улучшения отдаленных результатов лечения тромбоза глубоких вен нижних конечностей важно восстановить венозную функцию и отток. Повсеместно наиболее распространенным методом лечения заболевания остается антикоагулянтная терапия с использованием низкомолекулярного или нефракционированного гепарина. Однако тотальной или частичной резолюции тромбоза у пациентов, получающих антикоагулянтную терапию, удается добиться лишь в 4 и 14% соответственно. Тромболизис позволяет достигнуть раннего рассасывания тромба с помощью минимально инвазивной процедуры и уменьшить риск осложнений. С восстановлением венозного тока целью лечения становится предупреждение повреждения клапанного аппарата, венозной гипертензии и повторного тромбоза для предотвращения развития посттромботического синдрома. Преимуществом системного тромболизиса по сравнению с антикоагулянтной терапией считается более быстрое рассасывание сгустка и меньшее повреждение венозного клапана. Одно из серьезных ограничений метода – высокий риск кровотечения, связанный с назначением больших доз препарата, вводимого через периферический венозный катетер. В связи с этим было предложено селективное внутритромботическое введение тромболитиков (прямой катетерный тромболизис). Для более эффективного лечения с использованием меньших доз тромболитиков была разработана фармако-механическая тромбэктомия. Зачастую после прямого катетерного или фармако-механического тромболизиса выявляется стеноз вен, затрудняющий венозный отток. Ангиопластика со стентированием рекомендована в тех случаях, когда после успешного тромболизиса и тромбэктомии выявляется остаточное венозное поражение.

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