Pulmonary vein thrombosis after lobectomy with vein stump closure by ligation

Miyoshi, Ryo; Nishikawa, Shigeto; Tamari, Shigeyuki; Misa, Noguchi; Hijiya, Kyoko; Chihara, Koji

doi:10.1177/0218492318802141

Cited by 15 publications

(19 citation statements)

References 12 publications

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“…reported that longer pulmonary vein stumps are responsible for thrombosis development 19 . The length of the LSPV is longer than others, and the LSPV has the longest intrapericardial segment 10,20,21 . It was reported that thrombosis in the pulmonary vein stump was detected in 3.3%-3.6% of the patients who underwent lobectomy and in 13.5%-17.9% of those who underwent LUL 9,19 .…”

Section: Discussionmentioning

confidence: 93%

“…Major cardiovascular surgery around a relatively high incidence of perioperative stroke 6,7 . Recent studies found that left upper lobectomy (LUL) may be a new risk factor for stroke in cancer patients 8,9 , and the potential mechanism is pulmonary vein thrombosis, which more likely forms in the left superior pulmonary vein (LSPV) stump 9,10 . Interestingly, a giant thrombus in the LSPV after left pneumonectomy has been reported 11 .…”

Section: Introductionmentioning

confidence: 99%

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Both left upper lobectomy and left pneumonectomy are risk factors for postoperative stroke

Xie

Meng

et al. 2019

Sci Rep

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Retrospective studies have found that left upper lobectomy (LUL) may be a new risk factor for stroke, and the potential mechanism is pulmonary vein thrombosis, which more likely develops in the left superior pulmonary vein (LSPV) stump. The LSPV remaining after left pneumonectomy is similar to that remaining after LUL. However, the association between left pneumonectomy, LUL, and postoperative stroke remains unclear. Thus, we sought to analyze whether both LUL and left pneumonectomy are risk factors for postoperative stroke. We prospectively included consecutive patients who underwent resection between November 2016 and March 2018 at our institution with 6 months of follow-up. Baseline demographic and clinical data were taken. A logistic regression model was used to determine independent predictors of postoperative stroke. In our study, 756 patients who underwent an isolated pulmonary lobectomy procedure were screened; of these, 637 patients who completed the 6-month follow-up were included in the analysis. Multivariable logistic regression analysis adjusted for common risk factors showed that the LUL and left pneumonectomy were independent predictors of stroke (odds ratio, 18.12; 95% confidence interval, 2.12–155.24; P = 0.008). Moreover, diabetes mellitus also was a predictor of postoperative stroke. In conclusion, both LUL and left pneumonectomy are significant risk factors for postoperative stroke.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Both left upper lobectomy and left pneumonectomy are risk factors for postoperative stroke

Xie

Meng

et al. 2019

Sci Rep

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“…Based on the fact that postoperative cerebral infarction predominantly develops after left upper lobectomy (3), many clinicians attempted to clarify the pathogenesis and preventive measures that are effective against PV stump thrombus. Some clinicians speculated that the exclusive onset of PV stump thrombus after left upper lobectomy could be attributed to the significantly longer length of the PV stump after left upper lobectomy in comparison to after any other lobectomy (1,4,5). Unfortunately, although surgeons have attempted to reduce the length of the PV stump after left upper lobectomy by proximal ligation, PV stump thrombus was still found to develop in a proportion of patients after left upper lobectomy (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Some clinicians speculated that the exclusive onset of PV stump thrombus after left upper lobectomy could be attributed to the significantly longer length of the PV stump after left upper lobectomy in comparison to after any other lobectomy (1,4,5). Unfortunately, although surgeons have attempted to reduce the length of the PV stump after left upper lobectomy by proximal ligation, PV stump thrombus was still found to develop in a proportion of patients after left upper lobectomy (4,5). Because it appeared to be difficult to explain the pathogenesis of PV stump thrombus by simple anatomical evaluation of the PV stump, further studiesincluding dynamic studies-may be necessary to evaluate the blood flow in the left atrium or PV stump, to investigate the presence or absence of blood stasis or turbulence that may contribute to thrombus formation.…”

Section: Introductionmentioning

confidence: 99%

Four-dimensional flow magnetic resonance imaging study to explain high prevalence of pulmonary vein stump thrombus after left upper lobectomy

et al. 2020

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Background: Pulmonary vein (PV) stump thrombus, a known source of cerebral infarction, develops almost exclusively after left upper lobectomy; however, the mechanism remains unclear. We therefore evaluated the hemodynamics in the left atrium with four-dimensional flow magnetic resonance imaging (4D-flow MRI), which enables the simultaneous depiction of blood flow at three locations and the evaluation of hemodynamics. Methods: 4D-flow MRI was basically performed 7 days after lobectomy for cancer arising in the right upper lobe (n=11), right lower lobe (n=8), left upper lobe (n=13), or left lower lobe (n=8). We evaluated dynamic blood movement from the ipsilateral remaining PV, the resected PV stump, and the contralateral PVs into the left atrium using 4D-flow MRI.Results: There were some characteristic blood flow patterns that seemed to either promote or prevent PV stump thrombus. Promotive flow patterns were significantly more frequent and preventive flow patterns were significantly less frequent in patients who had undergone left upper lobectomy than in those who had undergone other lobectomy. Accordingly, the degree of blood turbulence near the vein stump, as measured by the extent of change in the blood movement, was significantly higher in patients who had undergone left upper lobectomy than in patients who had undergone other lobectomy. Conclusions: Our study revealed that left upper lobectomy likely causes blood turbulence near the vein stump through complicated blood streams in the left atrium, which can play a part in the development of vein stump thrombus. Further study to identify patients at high risk of vein stump thrombus is warranted.

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“…Cerebral infarction occurs at a high frequency in patients undergoing left upper lobectomy (LUL) for lung cancer [1][2][3][4][5][6]. Thrombus caused by a long pulmonary vein (PV) stump is associated with an increased risk of cerebral infarction [1,[4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Infarction After Lobectomy for Lung Cancer

Miura¹,

Miura²,

Honda³

2019

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Background and objective: The left upper lobectomy as treatment for lung cancer has been identified as a risk factor for cerebral infarction. We analyzed cases of surgery for lung cancer to clarify factors that increase the risk for postoperative cerebral infarction. Methods: This study included patients with primary lung cancer who underwent lobectomy or segmentectomy with >ND1 lymph node dissection from 2008 to 2014 at Hachioji Medical Center of Tokyo Medical University. In total, 479 patients (294 males and 157 females) were examined. Cases of cerebral infarction occurring within 30 days of surgery were retrospectively studied. All surgeries were performed under mini-thoracotomy with thoracoscopy support. Vessels >7 mm in diameter were amputated using a linear stapler. Results: Cerebral infarction occurred in four male patients, representing 0.8% (4/479) of all lung cancers and 1.4% (4/294) of all male patients. Of these four patients, three were in their 60s (1.4% of 157 patients in their 60s) and one was in his 70s (0.5% of 215 patients in their 70s). Two cases involved adenocarcinomas, and two involved squamous cell carcinomas. One patient underwent right upper lobectomy, two underwent right lower lobectomy, and one underwent left upper lobectomy. The cerebral infarctions occurred in a branch of the vertebral artery. The pons was impaired in three cases, and the cerebellum was impaired in one. Three patients had pl2 disease, and one patient had pl3 disease. Operative time was 4-5 h in two cases, 5-6 h in one, and >6 h in one. Only pl factor significantly differed between patients with and without postoperative cerebral infarction. Conclusions: To prevent cerebral infarction, the following factors should be considered: preoperative smoking cessation, operative positioning to protect the vertebral artery, shortening of operative time, and stronger anticoagulant therapy for high-risk patients, such as those with past history of transient ischemic attack.

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Pulmonary vein thrombosis after lobectomy with vein stump closure by ligation

Cited by 15 publications

References 12 publications

Both left upper lobectomy and left pneumonectomy are risk factors for postoperative stroke

Both left upper lobectomy and left pneumonectomy are risk factors for postoperative stroke

Four-dimensional flow magnetic resonance imaging study to explain high prevalence of pulmonary vein stump thrombus after left upper lobectomy

Cerebral Infarction After Lobectomy for Lung Cancer

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