OUTCOMES OF SURGICAL TREATMENT FOR PULMONARY EMBOLISM FOLLOWING PHLEBOLOGIC INTERVENTIONS
Aim. The aim of the study was to analyze the outcomes of surgical treatment for pulmonary embolism in the group of patients previously operated on for varicose vein disease of the lower extremities. Material and methods. Our study was based on the experience of surgical treatment for high-risk pulmonary embolism in a group of phlebologic patients who had previously undergone some type of surgical intervention for varicose vein disease of the lower extremities. The group of patients under investigation consisted of 9 patients, 7 (78%) of them were women. The mean age of the patients under investigation was (57,9±10,8) years (from 36 to 74 years). At the time of admission to the hospital, the patients’ condition was considered to be severe, determined by progressively increasing respiratory and cardiovascular insufficiency. Borg index at the moment of hospitalization was > 10 points, which was a direct indication for high-flow noninvasive oxygen therapy. Patients’ APACHE II status corresponded to (10+2) points. In all cases patients underwent embolectomy from the trunk and lobe branches of the pulmonary artery against the background of parallel perfusion of the artificial circulation, except for one patient, in whom the embolectomy stage preceded the stage of coronary artery bypass grafting, which was performed under pharmaco-cold cardioplegia. The duration of surgical intervention was (128±22,1) min. At the same time, the duration of parallel perfusion was (26,7±10,3) min. Aortic constriction, which was performed in one case during the coronary stage of the surgery, lasted 23 min. Results and discussion. The hospital survival rate of the patients was 100%. All patients were discharged from the hospital on (19,6±3,12) days (13 to 17 days) in a satisfactory condition, for subsequent outpatient treatment. Among non-lethal complications, cardiovascular and respiratory insufficiency prevailed, which determined the duration of artificial pulmonary ventilation up to (17,2±3,4) hours, as well as the use of a combined two-component scheme of inotropic myocardial stimulation, lasting up to (14±7,1) hours. The peak pulmonary artery pressure was (27,65±6,2) mmHg, whereas the mean was (18,4±3,1) mmHg. Conclusion. surgical treatment for varicose veins of the lower extremities is an independent risk factor for the development of VTE, which requires revision of risk stratification and changes in approaches to anticoagulant prevention. Surgical treatment for pulmonary embolism is a reasonable and reliable method due to the presence of absolute contraindications to thrombolytic therapy, as well as due to unsatisfactory anticoagulant therapy. We consider it justified to perform open surgical intervention as early as possible, under conditions of parallel perfusion by artificial circulation, without aortic clamping during the primary surgical phase.