Oklei D. Individualization of surgical technologies for the treatment of acute deep vein thrombosis of the lower extremities taking into account disturbances in phlebohemodynamics

The thesis is devoted to increase of efficiency of diagnostics and treatment of patients with acute deep vein thrombosis of the lower extremities based on the development and implementation of informative diagnostic methods, rational surgical tactics and individualization of surgical technologies. In the experimental part of the study, structural changes in the vascular wall were studied when modeling deep venous thrombosis of the posterior vena cava system in rats. Early morphological and functional changes (30 min) in the vein wall during thrombosis with impaired endothelial integrity and destructive changes in endotheliocytes are triggers for the further development of the pathological process and determine the further state of the vessels. In the clinical part of the study, an analysis of the results of examination and treatment using surgical, endovascular and conservative methods of 514 patients with acute deep vein thrombosis (DVT) of the lower extremities for the period from 2011 to 2018 was performed. As a result of the study, algorithms for the diagnosis and differentiated treatment of patients with DVT were proposed and implemented. An algorithm has also been developed for the treatment of venous thrombosis in patients with bleeding of various localization, which can prevent the progression of the thrombotic process and the development of VTEC. The introduction of the proposed individualized active tactics in the treatment of venous thrombosis contributed to an increase in positive results from 44.1% to 82.1%, and also allowed to reduce the incidence of severe CVI (C4-C6 according to CEAP) from 18.4% to 6.0% in the distant period. Key words: deep vein thrombosis of the lower extremities, individualization of surgical treatment technologies, impaired phlebohemodynamics.