Jornal Vascular Brasileiro
https://jvascbras.org/journal/jvb/article/doi/10.1590/1677-5449.005817
Jornal Vascular Brasileiro
Therapeutic Challenge

Trombo flutuante em veia femoral

Floating thrombi in femoral veins

Matheus Bertanha, Rafael Elias Farres Pimenta, Gustavo Muçouçah Sampaio Brandão, Marcone Lima Sobreira, Regina Moura, Rodrigo Gibin Jaldin, Paula Angeleli Bueno de Camargo, Winston Bonetti Yoshida

Downloads: 0
Views: 1574

Resumo

O trombo venoso flutuante em veia femoral é um tipo de trombo com alto potencial de embolização pulmonar. Entretanto, ainda é controversa a conduta mais apropriada nesses casos. Tratamentos clínicos com anticoagulantes ou fibrinolíticos e trombectomias abertas ou por meio de dispositivos endovasculares vêm sendo empregados ainda sem um critério de indicação bem definido. Apresentamos três casos clínicos de trombos flutuantes em veia femoral, de etiologias distintas, cujos tratamentos e respectivas evoluções serão discutidos.

Palavras-chave

trombose venosa; trombectomia; anticoagulantes; fibrinólise; embolia pulmonar.

Abstract

A floating venous thrombus in the femoral vein is a type of thrombus with a high potential for pulmonary embolization. However, the most appropriate management for these cases is still controversial. Clinical treatments, using anticoagulants or fibrinolytics, open thrombectomies, or thrombectomies by means of endovascular devices have all been used, although the criteria for indication of each are not yet defined. We present 3 clinical cases of floating thrombi in femoral veins with different etiologies and discuss their respective treatments and outcomes.

Keywords

venous thrombosis; thrombectomy; anticoagulants; fibrinolysis; pulmonary embolism.

References

1. 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.

2. Noel AA, Gloviczki P, Charboneau JW. Free-floating femoral vein thrombus in a patient with aspergillosis. Int Angiol. 2000;19(1):75-8. PMid:10853690.

3. Norris CS, Greenfield LJ, Herrmann JB. Free-floating iliofemoral thrombus: a risk of pulmonary embolism. Arch Surg. 1985;120(7):806-8. PMid:4015371. http://dx.doi.org/10.1001/archsurg.1985.01390310044009.

4. Raulin S, Raulin C, Greve B. Free-floating thrombus in the femoral vein--a challenge in phlebologic diagnostics. Eur J Dermatol. 2001;11(6):564-8. PMid:11701410.

5. Leon L, Giannoukas AD, Dodd D, Chan P, Labropoulos N. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg. 2005;29(1):10-7. PMid:15570265. http://dx.doi.org/10.1016/j.ejvs.2004.09.021.

6. Voet D, Afschrift M. Floating thrombi: diagnosis and follow-up by duplex ultrasound. Br J Radiol. 1991;64(767):1010-4. PMid:1742580. http://dx.doi.org/10.1259/0007-1285-64-767-1010.

7. Jorgensen JO, Hanel KC, Morgan AM, Hunt JM. The incidence of deep venous thrombosis in patients with superficial thrombophlebitis of the lower limbs. J Vasc Surg. 1993;18(1):70-3. PMid:8326661. http://dx.doi.org/10.1067/mva.1993.42072.

8. Araujo WJB, Timi JRR, Erzinger FL, Caron FC. Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literatura. J Vasc Bras. 2016;15(2):147-52. http://dx.doi.org/10.1590/1677-5449.009816.

9. Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ. Progression of superficial venous thrombosis to deep vein thrombosis. J Vasc Surg. 1996;24(5):745-9. PMid:8918318. http://dx.doi.org/10.1016/S0741-5214(96)70007-1.

10. Sobreira ML, Maffei FH, Yoshida WB, et al. Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases. Int Angiol. 2009;28(5):400-8. PMid:19935595.

11. 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. http://dx.doi.org/10.1016/j.chest.2015.11.026.

12. Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2016;11:CD002783. PMid:27830895.

13. Sobreira ML, Yoshida WB, Lastória S. Tromboflebite superficial: epidemiologia, fisiopatologia, diagnóstico e tratamento. J Vasc Bras. 2008;7(2):131-43. http://dx.doi.org/10.1590/S1677-54492008000200007.

14. Ascer E, Lorensen E, Pollina RM, Gennaro M. Preliminary results of a nonoperative approach to saphenofemoral junction thrombophlebitis. J Vasc Surg. 1995;22(5):616-21. PMid:7494365. http://dx.doi.org/10.1016/S0741-5214(95)70049-8.

15. Ranjbaran H, Wang Y, Manes TD, et al. Heparin displaces interferon-gamma-inducible chemokines (IP-10, I-TAC, and Mig) sequestered in the vasculature and inhibits the transendothelial migration and arterial recruitment of T cells. Circulation. 2006;114(12):1293-300. PMid:16940188. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.631457.

16. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e419S-94S.

17. Maffei FHA, Rollo HA, Lastória S. Tratamento anticoagulante das tromboses venosas. In: Maffei FHA, et al. Doenças Vasculares Periféricas. 5. ed. Rio de Janeiro: GEN; 2016. p. 1813-26.

18. Society of Interventional Radiology. ATTRACT Trial results provide insight into DVT therapy. Washington, D.C.: SIR, 2017 [citado 2017 jul 09]. http://www.sirtoday.org/attract-study/.

19. Comerota AJ. Catheter-directed thrombolysis for iliofemoral deep vein thrombosis: helpful or hurtful? Expert Rev Hematol. 2015;8(2):131-3. PMid:25652095. http://dx.doi.org/10.1586/17474086.2015.1007863.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5cd2e8680e8825220e632f90 jvb Articles

J Vasc Bras

Share this page
Page Sections