Phlebographic Findings in Venous Thrombosis following Total Hip Replacement

Abstract

The specific appearance of venous thrombosis following total hip replacement was analysed by reviewing 45 positive phlebograms from 122 patients participating in a concurrent trial against thromboembolism. Almost all thrombi were asymptomatic and non-occlusive. Forty-four per cent of the thrombi were excusively confined to the calf. The muscular veins were the most common location, followed by the fibular and posterior tibial veins. Ipsilateral thrombi predominated over thrombi in the non-operated leg. Thirty-six per cent were located in the ipsilateral thigh and the major part was found in the proximal part of the femoral veins. Nearly all were related to valve cusps, free-floating and were of small size. In 20 per cent, thrombi were found in both the calf and the thigh. Neither contralateral thigh thrombi, nor pelvic thrombi were found. Of 25 patients with pulmonary embolism, all but 3 asymptomatic, 64 per cent had thigh thrombi. A multifocallocation of thrombi was present but two major types of thrombosis were distinguished; calf vein thrombosis probably due to venous stasis and femoral thrombosis caused by the local surgical trauma.

Femoral Medullary Infarction Secondary to Canine Total Hip Arthroplasty

“…Subclinical thromboembolic events frequently occur during and shortly after THA in humans and in dogs 5–8 . However, clinical manifestations of thrombosis, such as thromboembolic disease or obliteration of femoral blood flow are uncommon 5,7,9–12 . Intramedullary infarction, as a radiographic diagnosis, has been observed after THA in asymptomatic dogs 3 .…”

Optimization of ascending phlebography of the leg for screening of deep vein thrombosis in thromboprophylactic trials

“…Recruitment of symptomatic individuals resulted in a higher incidence of DVT and higher inadequacy rates compared to a postoperative screening population (21,27). In postoperative patients under thromboprophylaxis, the thrombi are almost invariably small and free floating (27,42) in contrast to the symptomatic patients who often present adherent thrombi with long extensions. This difference contributes to the better adequacy of venous filling in asymptomatic patients compared to symptomatic ones although the same methodology is used.…”

“…Although at least 9 images are exposed of each leg, additional information might be gained by supplementing the 2 lateral calf views. This facilitates assessment of the soleal muscular veins which are frequently thrombosed following hip surgery (27) and might be one of several sources of pulmonary embolism (21,23).…”

“…Serious adverse reactions (including DVT) following phlebography is extremely low with the use of modern nonionic low-osmolar contrast media (1,4,11,21,27,32). The often quoted risk of postphlebographic DVT is based on inferior techniques that use the old ionic contrast media.…”

Is Pulmonary Embolism a Suitable Evaluation Criterion of the Efficacy of Prophylactic Treatment in Surgery?

“…4,5 To define our position, a typical example from the very extensive but uniform literature will be reviewed. In a comparative prophylactic trial of unfractionated heparin (UFH) compared with low molecular weight heparin 6 (LMWH), although 45 (37%) positive deep vein thromboses (DVTs) and 26 (21%) positive PEs were diagnosed by technical methods, only five DVTs and three PEs were clinically symptomatic ( Table 1). The answer to the above question given by J. Hirsh in 1987 is the following: "There is good evidence, which is now widely accepted, that clinical diagnosis of venous thrombosis and PE is highly nonspecific."…”