Incidence and risk factors of early deep venous thrombosis after varicose vein surgery with routine use of a tourniquet

Chen, Kai; Yu, Guan; Huang, Jing Yong; Huang, Li Dong; Su, Xiang Yao; Ni, Hai Zhen; Pan, Le; Zheng, Xiang Tao

doi:10.1016/j.thromres.2015.03.008

Cited by 13 publications

(8 citation statements)

References 14 publications

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“…Chen et al investigated the DVT risk in patients undergoing saphenous vein surgical stripping with intraoperative tourniquet application and documented a high rate of DVT. Proximal DVT events occurred in 1.3% of cases and isolated distal DVT events in 6.4% of cases [24]. The authors also enumerated DVT risk factors, which were older age (≥ 65 years), female sex, and gastrocnemius vein dilation [24].…”

Section: Deep Vein Thrombosis and Venous Thromboembolism Incidence Inmentioning

confidence: 99%

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

Wołkowski¹,

Urbanek²

2018

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Deep vein thrombosis (DVT) remains one of the most important clinical complications of varicose vein surgery. Despite the fact that procedures employed in the treatment of varicose veins are commonly classified as carrying a low risk of thromboembolism, this risk may vary significantly across different patients due to the presence of individual risk factors. This is a review of the risk of DVT in surgical and minimally invasive treatment of varicose veins. In retrospective studies addressing open varicose vein surgery, the rate of symptomatic DVT has been estimated at approximately 1%, but in prospective imaging-based studies, the risk of DVT in clinical settings seems to be much higher. The role of risk factors for DVT as well as their proper evaluation and individual risk stratification are significant. Because of population aging, a higher incidence of thromboembolic complications can be expected, suggesting the need for an individualised approach to risk stratification and appropriate risk-adjusted prophylaxis in patients who are candidates for varicose vein treatment. The implementation of new treatment modalities, in particular thermal and non-thermal ablation, does not eliminate the risk of DVT completely despite their relatively minimally invasive nature. Moreover, these methods can be related to the occurrence of new types of thrombotic complications, such as endovenous heat-induced thrombosis. The limited number of prospective studies regarding thromboembolism prophylaxis in modern phlebological treatment warrants further research on the importance of patient assessment and evaluation of procedure-related risk factors for venous thromboembolism.

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Section: Deep Vein Thrombosis and Venous Thromboembolism Incidence Inmentioning

confidence: 99%

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

Wołkowski¹,

Urbanek²

2018

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“…Similarly, SSV ligation and stripping was associated with the next highest rate of VTE (at 30 and 90 days), but again the small number of cases meant a signifi cant relationship could not be demonstrated. In a retrospective review of risk factors for post-operative DVT in 1,461 patients undergoing varicose vein stripping using tourniquet, Chen et al identifi ed several risk factors including age (greater than 65 at the time of surgery), female gender, and most signifi cantly gastrocnemius vein dilation [16] Foam sclerotherapy was the only procedure to demonstrate a signifi cantly lower rate of VTE compared to other procedures, although this eff ect was only observed at the 30 day point and did not persist beyond it. Unfortunately, the HES database does not distinguish between foam use in major truncal veins and its use for the treatment of minor varicosities or perforating veins.…”

Section: Number Of Vtes By Yearmentioning

confidence: 99%

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Barker

Evison

Benson

et al. 2017

Vasa

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Summary:Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson's Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15-0.35 % at 30 days, 0.26-0.50 % at 90 days, and 0.46-0.58 % at one year. At 30 days there was a signifi cantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other signifi cant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments. Keywords: Varicose veins, vascular surgical procedures, thrombosis, embolusThe wide range of reported incidences may be accounted for by the varying length of follow-ups in the studies and by whether routine duplex scanning was performed postoperatively or it was relied upon the development of clinical features of a DVT. The signifi cance of duplex identifi ed DVTs in the absence of clinical signs is uncertain; however, one series examining this problem reported no instances of a patients with early positive duplex fi ndings developing a clinical DVT on long term follow-up [3].The relative risk of DVT following diff erent VV procedures is currently unknown. NICE guidelines have highlighted the lack of large cohorts and high quality evidence, investigating this phenomenon, as the available evidence is limited to comparisons between two procedure types, with relatively small cohorts leading to identifi cation of sporadic events, which preclude in-depth statistical analysis. Currently the only reported comparisons are the ones between RFA and EVLA, which demonstrate no signifi cant diff erence in the incidence of DVT between these two procedures [5,10].

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“…To our knowledge, several studies have assessed the association between venous diameter and DVT [6, 9–12]. One study by Yamaki T et al [11] found that a larger diameter of the gastrocnemius vein was significantly associated with postoperative DVT in TJA patients, and they concluded that a cut-off diameter value larger than 0.25 cm for the gastrocnemius vein predicted postoperative DVT.…”

Section: Discussionmentioning

confidence: 99%

“…One study by Yamaki T et al [11] found that a larger diameter of the gastrocnemius vein was significantly associated with postoperative DVT in TJA patients, and they concluded that a cut-off diameter value larger than 0.25 cm for the gastrocnemius vein predicted postoperative DVT. Another study from Chen et al [9] that included 1,461 patients who underwent unilateral varicose vein surgery defined dilatation of the gastrocnemius vein as a diameter larger than 5 mm or 1.5 times the size of the normal side. The authors confirmed that the gastrocnemius vein diameter had the highest predictive power for postoperative DVT.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Evaluation of Soleal Vein Diameter by Ultrasound Is Beneficial for Prophylaxis of Deep Vein Thrombosis after Total Knee or Hip Arthroplasty

Yao

Qiao

Song

et al. 2018

BioMed Research International

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Purpose The purpose of this retrospective study was to determine the association between preoperative soleal vein (SV) diameter and deep vein thrombosis (DVT) following total joint arthroplasty (TJA). Methods A total of 402 patients were enrolled, with 229 patients undergoing total knee arthroplasty (TKA) and 173 patients undergoing total hip arthroplasty (THA). Ultrasonography was performed 1-3 days preoperatively, on postoperative days 1, 3, and 7, or before discharge and during follow-up. The SV diameter was assessed preoperatively. Univariate analysis and multivariate logistic regression analysis were used to compare parameters between the DVT group and the non-DVT group. Results 78 patients (19.4%) were found to have DVT during hospitalization and after discharge and 14 patients (3.5%) developed symptomatic DVT. Multiple regression analysis showed that SV diameter, advanced age, and surgery type were independent predictors of postoperative DVT. In the logistic regression analysis for symptomatic DVT, SV diameter was found to be the only predictor. In the receiver operating characteristics (ROC) analysis for the value of SV diameter in diagnosing DVT, the area under curve (AUC) was 0.701 ((95% CI 0.636-0.766), P<0.001) and when the cut-off value of SV diameter was set at 0.57 cm, the sensitivity and specificity of SV diameter were 62.7% and 72.1%, respectively. Conclusions SV diameter was an independent risk factor for total and symptomatic DVT after TJA. Preoperative ultrasound screening of the SV diameter may be beneficial for the prevention of postoperative DVT.

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Incidence and risk factors of early deep venous thrombosis after varicose vein surgery with routine use of a tourniquet

Cited by 13 publications

References 14 publications

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

A review of the risk of deep vein thrombosis in surgical and minimally invasive treatment of varicose veins

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Preoperative Evaluation of Soleal Vein Diameter by Ultrasound Is Beneficial for Prophylaxis of Deep Vein Thrombosis after Total Knee or Hip Arthroplasty

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