A case is reported of a 23-year-old male patient who developed, after severe
blunt injury of the lumbar region, massive
thrombosis of the vena cava inferior (VCI), both renal veins, bilateral pulmonary artery
thromboembolism (PATE),
nephrotic syndrome (NS). In spite of
anticoagulant therapy, the condition of the patient progressively aggravated for 1.5 year:
thrombosis involved the ileac and femoral arteries on the right,
thrombus floated in the right atrium with PATE recurrent episodes,
pulmonary hypertension reached 120 mm Hg with formation of decompensated cor pulmnonale,
proteinuria and
hypoalbuminemia deteriorated,
anasarca edema developed Multigenic
thrombophilia was diagnosed (1 homozygous and 5 heterozygous mutations). A radical one-stage operation was successful: thromboectomy from the VCI, right ileac and left renal veins, thrombendarterectomy from the pulmonary arteries,
suture of the interatrial septum defect, installation of cava-filter After the operation pulmonary pressure lowered to 40-45 mm Hg, right heart volume normalized, immunosuppressive therapy with
prednisolone and
cyclosporine led to nephropathy remission. The discussion covers mechanisms and factors (including genetic) of
thrombosis progression, correlations between intravascular
thrombosis, NS and chronic
glomerulonephritis (possible NS development due to bilateral
thrombosis of the renal veins and nephropathy role in
thrombosis progression), approaches to conservative and surgical treatment of such patients. Global experience in conduction of pulmonary thrombendarterectomy and
thrombectomy from VCI is reviewed (one-stage operations were not described earlier).