Résumé
In an attempt to select the most appropriate treatment modality in patients with deep vein thrombosis [DVT] complicated by pulmonary embolism [PE], 90 patients with DVT and PE were divided into three groups. Group I included 30 patients [12 males and 18 females; with average age of 51.8 +/- 4.2 years] who underwent full heparinisation with maintenance on oral anticoagulants after stabilization of the condition for a period of at least three months. Group II included 30 patients [14 males and 16 females; with average age of 47.5 +/- 8.4] who underwent thrombolytic therapy using streptokinase and followed by heparinisation. Group III included 30 patients [10 males and 20 females; with average age of 53.3 +/- 5.3 years] who underwent primary Greenfield [GF] inferior vena caval [IVC] filter insertion. The filters were inserted through a trans-jugular or a trans-femoral route under general anesthesia [GA] in 18 patients and local anesthesia in 12 patients. The overall mortality showed statistically significant decrease between patients to whom IVC filters were inserted in comparison to the other two groups. The overall hospital study, ICU stay and incidence of bleeding was significantly less in group III. The incidence of hematoma was higher in group III as expected with this invasive technique. To sum up, 1ry IVC filters insertion is a superior technique for management of DVT with established or high risk of PE provided there is an experienced team with the proper equipment to manage these critical cases