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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">asurgery</journal-id><journal-title-group><journal-title xml:lang="ru">Амбулаторная хирургия</journal-title><trans-title-group xml:lang="en"><trans-title>Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2712-8741</issn><issn pub-type="epub">2782-2591</issn><publisher><publisher-name>ООО «ГРУППА РЕМЕДИУМ»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21518/akh2025-013</article-id><article-id custom-type="elpub" pub-id-type="custom">asurgery-527</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ФЛЕБОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>PHLEBOLOGY</subject></subj-group></article-categories><title-group><article-title>Эффективность и безопасность применения кава-фильтров у пациентов с крайне высоким риском возникновения венозных тромбоэмболических осложнений</article-title><trans-title-group xml:lang="en"><trans-title>Efficacy and safety of cava filters in patients with an extremely high risk of venous thromboembolic complications</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6027-2898</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бочаров</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Bocharov</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бочаров Александр Владимирович, д.м.н., заведующий отделением рентгенохирургических методов диагностики и лечения, 119071, Москва, Ленинский проспект, д. 27;</p><p>ассистент кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1</p></bio><bio xml:lang="en"><p>Alexander V. Bocharov, Dr. Sci. (Med.), Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment, 27 Leninsky Ave., Moscow, 119071;</p><p>Assistant of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997</p></bio><email xlink:type="simple">bocharovav@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9189-0413</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Савостьянов</surname><given-names>К. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Savostyanov</surname><given-names>K. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Савостьянов Кирилл Александрович, к.м.н., врач по рентгенэндоваскулярной диагностике и лечению, 119071, Москва, Ленинский проспект, д. 27;</p><p>заведующий отделением рентгенохирургических методов диагностики и лечения, 119048, Москва, ул. Трубецкая, д. 8стр. 2</p></bio><bio xml:lang="en"><p>Kirill A. Savostyanov, Cand. Sci. (Med.), Doctor for X-ray Endovascular Diagnostics and Treatment, 27 Leninsky Ave., Moscow, 119071;</p><p>Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment, 8, Bldg. 2, Trubetskaya St., Moscow, 119991</p></bio><email xlink:type="simple">dr.savostyanov@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-3816-0652</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Михайленко</surname><given-names>В. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Mikhailenko</surname><given-names>V. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Михайленко Виталий Павлович, врач – сердечно-сосудистый хирург Центра сосудистой хирургии,</p><p>119071, Москва, Ленинский проспект, д. 27</p></bio><bio xml:lang="en"><p>Vitaly P. Mikhailenko, Cardiovascular Surgeon at the Center for Vascular Surgery,</p><p>27 Leninsky Ave., Moscow, 119071</p></bio><email xlink:type="simple">vitummik@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4298-950X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дизенгоф</surname><given-names>И. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Dizengof</surname><given-names>I. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дизенгоф Игорь Михайлович, к.м.н., заместитель главного врача по хирургии, 119071, Москва, Ленинский проспект,д. 27;</p><p>ассистент кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1</p></bio><bio xml:lang="en"><p>Igor M. Dizengoff, Cand. Sci. (Med.), Deputy Chief Physician for Surgery, 27 Leninsky Ave., Moscow, 119071;</p><p>Assistant of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997</p></bio><email xlink:type="simple">idizengof@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6077-4839</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Куфа</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kufa</surname><given-names>M. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Куфа Мария Анатольевна, заместитель главного врача по медицинской части,</p><p>119071, Москва, Ленинский проспект, д. 27</p></bio><bio xml:lang="en"><p>Maria A. Kufa, Deputy Chief Medical Officer,</p><p>27 Leninsky Ave., Moscow, 119071</p></bio><email xlink:type="simple">kufa@ckbsva.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6381-5651</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Заров</surname><given-names>А. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Zarov</surname><given-names>A. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Заров Алексей Юрьевич, к.м.н., главный врач,</p><p>119071, Москва, Ленинский проспект, д. 27</p></bio><bio xml:lang="en"><p>Alexey Yu. Zarov, Cand. Sci. (Med.), Chief Physician,</p><p>27, Leninsky Ave., Moscow, 119071</p></bio><email xlink:type="simple">zarov@ckbsva.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4488-9123</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Болдин</surname><given-names>Б. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Boldin</surname><given-names>B. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Болдин Борис Валентинович, д.м.н., профессор, заведующий кафедрой факультетской хирургии №2,</p><p>117997, Москва, ул. Островитянова, д. 1</p></bio><bio xml:lang="en"><p>Boris V. Boldin, Dr. Sci. (Med.), Professor, Head of the Department of Faculty Surgery No. 2,</p><p>1, Ostrovityanov St., Moscow, 117997</p></bio><email xlink:type="simple">facultysurgery@gmail.com</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3574-6190</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Варич</surname><given-names>Г. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Varich</surname><given-names>G. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Варич Георгий Александрович, к.м.н., доцент кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1;</p><p>заместитель главного врача по хирургии, 141407, Московская область, Химки, Куркинское шоссе, д. 11</p></bio><bio xml:lang="en"><p>Georgе A. Varich, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997;</p><p>Deputy Chief Physician for Surgery, 11, Kurkinskoe Shosse, Moscow Region, Moscow, 141407</p></bio><email xlink:type="simple">geravarich@mail.ru</email><xref ref-type="aff" rid="aff-5"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Центральная клиническая больница Святителя Алексия митрополита Московского Московской патриархии Русской Православной Церкви;&#13;
Российский национальный исследовательский медицинский университет имени Н.И. Пирогова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Central Clinical Hospital of St. Alexy Metropolitan of Moscow of the Moscow Patriarchate of the Russian Orthodox Church;&#13;
Pirogov Russian National Research Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Центральная клиническая больница Святителя Алексия митрополита Московского Московской патриархии Русской Православной Церкви;&#13;
Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Central Clinical Hospital of St. Alexy Metropolitan of Moscow of the Moscow Patriarchate of the Russian Orthodox Church;&#13;
Sechenov First Moscow State Medical University (Sechenov University)</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Центральная клиническая больница Святителя Алексия митрополита Московского Московской патриархии Русской Православной Церкви</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Central Clinical Hospital of St. Alexy Metropolitan of Moscow of the Moscow Patriarchate of the Russian Orthodox Church</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Российский национальный исследовательский медицинский университет имени Н.И. Пирогова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Pirogov Russian National Research Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>Российский национальный исследовательский медицинский университет имени Н.И. Пирогова;&#13;
Химкинская областная больница</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Pirogov Russian National Research Medical University;&#13;
Khimki Regional Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>09</day><month>06</month><year>2025</year></pub-date><volume>22</volume><issue>1</issue><fpage>41</fpage><lpage>49</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Бочаров А.В., Савостьянов К.А., Михайленко В.П., Дизенгоф И.М., Куфа М.А., Заров А.Ю., Болдин Б.В., Варич Г.А., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Бочаров А.В., Савостьянов К.А., Михайленко В.П., Дизенгоф И.М., Куфа М.А., Заров А.Ю., Болдин Б.В., Варич Г.А.</copyright-holder><copyright-holder xml:lang="en">Bocharov A.V., Savostyanov K.A., Mikhailenko V.P., Dizengof I.M., Kufa M.A., Zarov A.Y., Boldin B.V., Varich G.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.a-surgeon.ru/jour/article/view/527">https://www.a-surgeon.ru/jour/article/view/527</self-uri><abstract><sec><title>Введение</title><p>Введение. В клинической практике встречаются особые ситуации, когда адекватная антикоагулянтная терапия не может быть назначена или не предотвращает рецидивы ТЭЛА. В подобных случаях имплантация кава-фильтра кажется оптимальной тактикой лечения, однако клиническая эффективность и спектр возможных побочных эффектов этих устройств остаются неясными.</p></sec><sec><title>Цель</title><p>Цель. Оценить эффективность и безопасность имплантации кава-фильтров в нижнюю полую вену для профилактики ТЭЛА.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. В исследование были включены 530 пациентов с тромбозом глубоких вен нижних конечностей и крайне высоким риском возникновения ТЭЛА в период с 2008 по 2024 г. Группу CVF составили 278 пациентов, которым был имплантирован кава-фильтр в нижнюю полую вену, группу non-CVF – 252 пациента, отказавшиеся от имплантации CVF, но имевшие показания к его имплантации. Все пациенты наблюдались в консультативно-диагностической поликлинике сердечно-сосудистым хирургом и получали адекватную антикоагулянтную терапию и терапию сопутствующих заболеваний. Первичными конечными точками исследования являлись смерть от любых причин, подтвержденная ТЭЛА с клиническими проявлениями, большое или умеренное кровотечение, развитие синдрома нижней полой вены. Вторичной точкой в группе CVF была эмболия в кава-фильтр по данным ультразвукового исследования.</p></sec><sec><title>Результаты</title><p>Результаты. Достоверных различий между группами по клинико-демографическим показателям, первичным конечным точкам получено не было. Частота обнаружения тромботических масс в кава-фильтре на госпитальном этапе составила 23 случая (8,27%). В подгруппах пациентов со злокачественными новообразованиями и проводимой химиотерапией, тяжелой травмой не было получено достоверных различий по первичным конечным точкам.</p></sec><sec><title>Обсуждение</title><p>Обсуждение. При анализе рекомендаций имплантацию CVF в НПВ рекомендуется рассмотреть в особых случаях, однако, согласно указаниям ACCP, AHA и BSH у всех пациентов с ТГВ н/к и/или ТЭЛА, которым может быть назначена антикоагулянтная терапия, показания к имплантации CVF отсутствуют. Результаты проведенного исследования подтверждают правильность этих указаний.</p></sec><sec><title>Выводы</title><p>Выводы. В настоящее время имплантация кава-фильтра для профилактики ТЭЛА не имеет преимуществ по сравнению с адекватной антикоагулянтной терапией. Любая имплантация кава-фильтра как потенциально небезопасного устройства должна осуществляться только после решения мультидисциплинарного консилиума.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Introduction</title><p>Introduction. In clinical practice, there are special situations when adequate anticoagulant therapy cannot be prescribed or does not prevent recurrence of PE. In such cases, the implantation of a cava filter seems to be the optimal treatment strategy, but the clinical efficacy and range of possible side effects of these devices remain unclear.</p></sec><sec><title>Aim</title><p>Aim. To evaluate the effectiveness and safety of implantation of cava filters into the inferior vena cava for the prevention of PE.</p></sec><sec><title>Materials and methods</title><p>Materials and methods. The study included 530 patients with deep vein thrombosis of the lower extremities and an extremely high risk of PE in the period from 2008 to 2024. The CVF group consisted of 278 patients who had a cava filter implanted in the inferior vena cava, and the non-CVF group consisted of 252 patients who refused CVF implantation but had indications for its implantation. The primary endpoints of the study were death from any cause, confirmed PE with clinical manifestations, large or moderate bleeding, and the development of inferior vena cava syndrome. The secondary point in the CVF group was an embolism in the cava filter according to ultrasound examination.</p></sec><sec><title>Results</title><p>Results. There were no significant differences between the groups in terms of clinical and demographic indicators, primary endpoints. The frequency of detection of thrombotic masses in the cava filter at the hospital stage was 23 cases (8.27%).</p></sec><sec><title>Discussion</title><p>Discussion. When analyzing the Recommendations, CVF implantation in NSAIDs is recommended to be considered in special cases, however, according to the instructions of the ACCP, AHA and BSH, there are no indications for CVF implantation in all patients with DVT and/or PE who may be prescribed anticoagulant therapy.</p></sec><sec><title>Conclusion</title><p>Conclusion. Any implantation of a cava filter, as a potentially unsafe device, should be carried out only after the decision of a multidisciplinary consultation.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>кава-фильтр</kwd><kwd>тромбоэмболия легочной артерии</kwd><kwd>антикоагулянтная терапия</kwd><kwd>тромбоз глубоких вен</kwd><kwd>травма</kwd><kwd>онкология</kwd></kwd-group><kwd-group xml:lang="en"><kwd>cava-filter</kwd><kwd>acute pulmonary embolism</kwd><kwd>anticoagulant therapy</kwd><kwd>deep vein thrombosis</kwd><kwd>trauma</kwd><kwd>oncology</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Оруджева СА, Митиш ВА, Ушаков АА, Магомедова СД, Блатун ЛА, Пасхалова ЮС. Осложнения тромбоза глубоких вен: тромбоэмболия легочной артерии и венозная гангрена нижних конечностей (клиническое наблюдение). Раны и раневые инфекции. Журнал имени проф. Б.М. 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