Occlusion of large veins

Iliofemoral region (phlegmasia alba et coerulea dolens), v. cava inferior, axilosubclavian region, v. cava superior – Perthes syndrome (blue mask).

Closure in. cava inferior

Causes

Thrombosis proceeding from the iliac region (high risk of pulmonary embolism). Also venostasis in right heart insufficiency. Ongoing thrombosis of the hepatic veins (Budd-Chiari syndrome). Tumor progression – Grawitz, hepatocellular carcinoma. Complications of catheterization. Post-operative (liver transplant...).

Clinical manifestations

Pains in the abdomen, lower abdomen, lumbar region, sometimes shoot to DK. Venostasis of the liver (hepatomegaly), ascites, swelling of both DK. Renal insufficiency.

Diagnosis

Cavography.

Treatment

Dilation, event by inserting a stent. The operation is very risky (necessary circulatory arrest in deep hypothermia).

Closure of the axillosubclavian region

Causes

Most often as a complication of CVK, pacemaker insertion, with TOS or after excessive exertion or sports (tennis...), pulmonary embolism (very rare).

Clinical manifestations

Swelling, light cyanosis, filling of superficial veins HK.

Diagnosis

Using ultrasound.

Treatment

Conservative (elevation, cold compresses, antiphlogistics for lighter forms). Local fibrinolysis with subsequent heparinization is optimal. Surgical treatment – ​​thrombectomy.

Superior v. cava syndrome

Causes

Malignant mediastinal tumors (bronchogenic carcinoma, non-Hodgkin's lymphoma), or thrombosis complicating an established CVK.

Clinical manifestations

Swelling of the neck, face and HK, cyanosis, changes from cerebral edema (behavior and consciousness disturbances, papilledema), often dyspnea.

Diagnosis

Phlebography (after managing the acute condition, look for the cause - tumor).

Treatment

  • Thrombosis – remove the catheter, fibrinolysis with subsequent anticoagulant therapy.
  • Signs of cerebral edema - corticoids, mannitol.
  • Tumor - radiotherapy.
  • Surgical solution – bypass, stent insertion.

Source

  • BENEŠ,. Otázky z chirurgie [online]. ©2007. [cit. 2010-06-28]. <jirben2.chytrak.cz/materialy/chira/cevni.doc>.