Lower-extremity venous stasis during laparoscopic cholecystectomy as assessed using color Doppler ultrasound

Abstract

Lower-extremity venous stasis during laparoscopic cholecystectomy was evaluated in 16 patients by monitoring the blood velocity in the femoral vein and the femoral vein size (cross-sectional area) using color Doppler ultrasonography. The blood velocity in the femoral vein decreased significantly after the start of 10-mmHg abdominal insufflation in the supine position. When the patients were placed in a reverse Trendelenburg position during 10-mmHg insufflation, blood velocity in the femoral vein further decreased. However, velocity returned to the baseline after deflation. The cross-sectional area of the femoral vein was significantly elevated after the start of 10 mm Hg insufflation in the supine position. When patients were placed in the reverse Trendelenburg position during 10-mmHg insufflation, this parameter was further elevated, but returned to the baseline soon after deflation. These results indicate that femoral vein stasis during laparoscopic cholecystectomy can be minimized by reducing the pressure of abdominal insufflation and avoiding elevation of the patient's head as much as possible.

Duplex ultrasound assessment of femoral venous flow during laparoscopic and open gastric bypass

“…In our study, use of the reverse Trendelenburg position during open GBP decreased femoral peak systolic velocity by 38%, whereas reverse Trendelenburg position with pneumoperitoneum during laparoscopic GBP reduced femoral peak systolic velocity by 57% of the baseline value as compared with a 43% reduction in femoral peak systolic velocity during pneumoperitoneum alone. Our findings are in keeping with the observations of other investigators who demonstrated that combining the reverse Trendelenburg position with pneumoperitoneum has an additive effect and decreases femoral peak systolic velocity by 42-61% [4,7].…”

“…Pneumoperitoneum during laparoscopy clearly has been shown to induce venous stasis by reducing femoral peak systolic velocity [1,2,4], increasing femoral venous pressure [2], and reducing femoral venous flow [9]. Beebe et al [2] reported that abdominal insufflation to 14 mmHg decreased femoral peak systolic velocity by 26% and increased femoral venous pressure by 78%; deflation of the abdomen lowered femoral venous pressure and returned femoral peak systolic velocity to baseline levels.…”

“…The cross-sectional area of the femoral vein has been shown to increase with pneumoperitoneum and the reverse Trendelenburg position [1,4]. Moneta et al [8] reported that there is a linear, inverse relationship between femoral peak systolic velocity and common femoral vein diameter.…”

“…The increased intraabdominal pressure at 15 mmHg has a direct compressive effect on the inferior vena cava and internal iliac veins and decreases lower extremity venous flow [2]. Due to the force of gravity and the compressive effects of abdominal viscera on the internal iliac veins, the reverse Trendelenburg position also has been shown to decrease femoral venous flow [4]. …”

“…Despite these benefits, there is concern about the risk of deep venous thrombosis after laparoscopic operations. Several investigators have demonstrated that certain intraoperative factors during laparoscopic operations-increased intraabdominal pressure and reverse Trendelenburg position-promote the development of venous stasis [1,2,4,7]. The increased intraabdominal pressure at 15 mmHg has a direct compressive effect on the inferior vena cava and internal iliac veins and decreases lower extremity venous flow [2].…”