Показаны ли кава – фильтры больным с венозными тромбозами, получающими адекватную антикоагулянтную терапию. 


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Показаны ли кава – фильтры больным с венозными тромбозами, получающими адекватную антикоагулянтную терапию.



- Рекомендации. Постановку кава – фильтра можно рассматривать выборочно у больных с легочной эмболией, случившуюся, несмотря на проводимую адекватную терапию антикоагулянтами (уровень доказательств - IV).

Показаны ли кава - фильтры во время беременности?

- Рекомендации. Постановка кава – фильтра у беременных рассматривается при наличии противопоказаний к антикоагулянтной терапии и развитии обширного венозного тромбоза незадолго до родоразрешения (в течении 2 недель) (уровень доказательств - IV).

Показаны ли кава – фильтры больным со свободно располагающимися (флотирующими) тромбами?

- Рекомендации. Наличие свободно флотирирующего тромба не является показанием для постановки кава – фильтра (уровень доказательств - III).

Показаны ли кава- фильтры больным, получающим тромболитическую терапию по поводу глубокого венозного тромбоза?

- Рекомендации. Тромболизис не является показанием к установке кава-фильтра, так как последний не снижает частоту фатальной легочной эмболии (уровень доказательств - IV).

Показаны ли кава-фильтры больным в дооперационном периоде при выявлении тромбоза глубоких вен?

- Рекомендации. Кава – фильтры должны использоваться в предоперационном периоде у всех пациентов с острыми венозными тромбозами, у которых невозможна антикоагулянтная терапия (уровень доказательств - IV).

Показана ли постановка кава – фильтра больным с хронической постэмболической легочной гипертензией?

- Рекомендации. Кава–фильтры могут использоваться у пациентов с хронической постэмболической легочной гипертензией (особенно, после легочной эндартериоэктомии) (уровень доказательств - IV).

Местоположение фильтра

Типичное размещение кава-фильтра - ниже почечных вен (нижний фильтр). Надпочечный уровень установки может потребоваться при локализации тромба выше почечных вен (верхний фильтр). В последнем случае имеется риск окклюзии почечной вены и ухудшения функции почек. В исключительных случаях фильтр может быть помещен в верхнюю полую вену, но клинических данных относительно данной методики недостаточно.

Осложнения при постановке кава-фильтра

Непосредственные осложнения:

- нарушение расположения (1–3%);

- пневмоторакс (0,02%);

- гематома (0,6%);

- воздушная эмболия (0,2%);

- артерио – венозный свищ (0,02%).

Непосредственных осложнений можно в значительной степени избежать при выполнении венопункции и последующего размещения фильтра под контролем ультразвука и рентгеноскопии. Условия со стороны системы гемостаза: МНО и АЧТВ не должны превышать норму более, чем в 1,5 раза.

Ранние осложнения:

- тромбоз в месте постановки (8,5%);

- инфекция.

Поздние осложнения:

- повторный глубокий венозный тромбоз (21%);

- тромбоз нижнего кава-фильтра (2-10%);

- посттромботический синдром (15-40%);

- пенетрация нижнего кава-фильтра (0,3%);

- миграция фильтра (0,3%);

- смещение и перелом фильтра.

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ГЛАВА VI.



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