[Venous stenting in acute period of total and subtotal deep vein thrombosis]. / Effektivnost' venoznogo stentirovaniya v ostrom periode total'no-subtotal'nykh trombozov glubokikh ven.

OBJECTIVE: To study the efficacy and safety of venous stenting and long-term anticoagulation with inhibitors of blood clotting factor XA in the treatment of total and subtotal deep vein thrombosis. MATERIAL AND METHODS: We analyzed 60 patients with total and subtotal deep vein thrombosis divided into 2 comparable groups by 30 people. Patients of the first group underwent regional catheter thrombolysis and percutaneous mechanical thrombectomy. The same endovascular treatment supplemented by venous stenting was performed in the second group. In the first group, rivaroxaban was prescribed before, during and for 6 months after surgery; apixaban was used in the second group. Complications of endovascular and anticoagulant therapy were recorded. After 12 months, control ultrasound and clinical examination of patients was performed to analyze recanalization of deep veins and severity of venous outflow disorders. Recanalization of veins was evaluated as follows: less than 50% - minimal, 50-99% - partial, 100% - complete. RESULTS: In the first group, complete and partial recanalization of veins was found in 63.3 and 36.7% of patients, respectively. In the second group, these values were 93.3 and 6.7%, respectively. In the first group, venous outflow disorders were absent in 56.7%, mild violations presented in 36.6%, moderate violations - in 6.7% of patients. In the second group, venous outflow was normal in 93.3% of patients, and mild disorders presented in 6.7% of patients. Hemorrhagic complications developed in 8 (13.3%) patients, equally in both groups.

[Efficacy of percutaneous mechanical thrombectomy for proximal deep vein thrombosis]. / Effektivnost' chreskozhnoi mekhanicheskoi trombektomii pri lechenii proksimal'nogo tromboza glubokikh ven nizhnikh konechnostei.

OBJECTIVE: To study the efficacy and safety of percutaneous mechanical thrombectomy and long-term anticoagulation with rivaroxaban for proximal deep vein thrombosis. MATERIAL AND METHODS: We analyzed the effectiveness of treatment in 60 patients with proximal deep vein thrombosis divided into 2 homogeneous groups by 30 people. Standard therapy was performed in the first group, therapy with percutaneous mechanical thrombectomy was applied in the second group. Patients received rivaroxaban in preoperative, perioperative and 6-month postoperative period. We considered complications of endovascular treatment and anticoagulation. Ultrasound and clinical examination were carried out after 12 months to analyze restoration of deep vein patency and venous outflow disorders. Recovery of vein lumen was assessed as follows: <50% - minimal, 50-99% - partial, 100% - complete. RESULTS: Recurrent deep vein thrombosis was found in 2 (6.7%) patients of the second group. Hemorrhagic complications following rivaroxaban therapy occurred in 8 (13.3%) patients (equally in both groups). In the first group, complete restoration of vein lumen was found in 16.7% of patients, partial recovery - in 40%, minimal recovery - in 43.3% of patients. In the second group, these values were 16.7%, 60% and 23.3%, respectively. Severe venous outflow impairment developed in 43.3% of patients in the first group and 23.3% of patients in the second group. Moderate impairment occurred in 30% and 20% of patients, mild disorders - in 10% and 40% of patients, respectively. CONCLUSION: Percutaneous mechanical thrombectomy on the background of long-term anticoagulation with rivoroxaban improves treatment outcomes in patients with proximal deep vein thrombosis.

[Peculiarities of sonoelastographic imaging of thyroid papillary cancer in presence of autoimmune thyroiditis].

AIM: To determine the features of visualization of papillar thyroid cancer (PTC) in presence of autoimmune thyroiditis (AIT) according to sonoelastography data. MATERIALS AND METHODS: 155 patients were examined (75 PTC, 30 AIT, 20 PTC in presence of AIT and 30 with diffuse parenchymal changes) and 30 patients of the control group. Among patients with PTC 68 (90.7%) were represented by female (mean age 46.713.12 years) and 7 (9.3%) by male (average age 48.14.05 years) patients, PTC in presence of AIT by 19 female (average age 46.916.98 years) and 1 male (22 years) patients. Ultrasound investigation was performed with devices Toshiba Aplio-400 and Toshiba Aplio-500 (Japan) by the standard method and using elastography. A surface transducer with a frequency of 1014 MHz was used. An analysis of the thyroid ultrasound image was performed in correspondence with TI-RADS. For a qualitative assessment of the elastographic picture of thyroid foci, the TsukubaUeno assessment visual standardized system was implemented. RESULTS: According to the TI-RADS scale, most nodular formations are assigned to category 4. With TPC with an unchanged thyroid gland, category 4 was determined in 52 patients (69.3%), and with PR in presence of AIT 15 patients (75%). When determining the qualitative criteria for Tsukuba Ueno, the majority of tumors were assigned to types 3b and 4: cancers in presence of AIT 95% and cancers with no changes to thyroid gland 81.3%. Sonoelastographic criteria for thyroid parenchyma with AIT with a high degree of confidence are significantly higher than in the control group (p0.000). In a comparative analysis of thyroid sonoelastography in PTC with unchanged parenchyma and AIT, changes according to compression elastography are statistically unreliable. In shear wave elastography, sonoelastographic criteria for PTC are significantly higher in patients with AIT (p0.02 when measured in kPa, p0.01 when measured in m/s). CONCLUSION: Sonoelastography data can be used as additional criteria in the differential diagnosis of focal thyroid formations.