Pulmonary vein thrombosis and cerebral infarction after video-assisted thoracic surgery of the left upper lobe: a case series

Fujii, Yosuke; Mori, Yumiko; Kambara, Kei; Hirota, Kaoru; Yanada, Masashi; Toda, Shogo; Hashiguchi, Mitsuko

doi:10.1186/s40981-020-00378-9

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…Anticoagulation may be recommended in an individual basis given those contradictory findings regarding the occurrence of cerebral infarction after PVST [16]. In addition, previous studies reported the use of several different anticoagulants including warfarin or dabigatran for the management of PVST, but there are yet no preferred duration or modality of anticoagulation [1,9,12]. Low-molecular-weight heparin (LMWH) treatment is associated with enhanced activity of the fibrinolytic system [22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Left upper lobectomy and left pneumonectomy are suggested to be the independent risk factors for the development of early postoperative stroke [18]. However, whether PVST is the direct cause of postoperative cerebral infarction is not yet clear [12,20]. No patient experienced systemic embolism (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…stroke and renal infarction in postoperative patients) [3]. Among them, cerebral infarction can be a life-threatening condition and several studies suggested that PVST may be the direct source of postoperative cerebral infarction [11][12][13]. Evidence regarding PVST management is insufficient, and suggested options include systemic anticoagulation and more aggressive approaches (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary vein stump thrombosis after lung resection for lung cancer: clinical features and outcome

Park¹,

Cha²,

Lee

et al. 2022

Blood Coagulation &Amp; Fibrinolysis

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Pulmonary vein stump thrombosis (PVST) is uncommonly encountered postoperative in-situ thrombosis in the stump of pulmonary veins after lung resection. Data regarding the incidence and clinical behaviour of PVST are scarce. Thus, this study aims to investigate the incidence, clinical characteristics and outcome of PVST after lung resection in patients with lung cancer. Follow-up enhanced chest computed tomography (CT) scans acquired after the surgery were retrospectively reviewed to determine PVST presence for patients with lung cancer who underwent lung resection in two tertiary referral centres. Out of the 1885 patients with lung cancer who underwent lobectomy or more extensive lung resection, PVST was observed in 37 patients (2.0%) on their follow-up chest CT. Most stump thrombi were observed in the left superior pulmonary vein [35 (94.6%)] and in patients who underwent left upper lobectomy [34 (91.9%)]. At the last CT follow-up of each patient, 33 (89.2%) exhibited complete resolution, three partial resolution and one stabilization. Eleven (29.7%) patients received anticoagulant therapy after the diagnosis. The rate of complete PVST resolution did not differ significantly between the anticoagulation and nonanticoagulation groups. None of the PVST patients experienced systemic embolic events, regardless of anticoagulation. The PVST incidence diagnosed at routine chest CT follow-up following lung cancer surgery was 2%. PVST was characterized by a benign clinical course without progression and systemic embolization, regardless of anticoagulation. However, further studies are required to determine individualized therapeutic strategies, including anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary vein stump thrombosis after lung resection for lung cancer: clinical features and outcome

Park¹,

Cha²,

Lee

et al. 2022

Blood Coagulation &Amp; Fibrinolysis

View full text Add to dashboard Cite

show abstract

“…Thrombosis at the pulmonary vein transection site reportedly occurs in 11.7-30.8% of patients undergoing left upper lobectomy [1,3,4]. Care must be taken because cerebral infarction is relatively frequently reported after left upper lobectomy [4,5], and left pneumonectomy and left upper lobectomy are considered independent risk factors for postoperative stroke [6].…”

Section: Discussionmentioning

confidence: 99%

Dyspnea after discharge from hospital due to pulmonary vein thrombosis after video-assisted left upper lobectomy: a case report

et al. 2022

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Background Thrombus formation at the pulmonary vein transection site is more common in left upper lobectomy than other lobectomies. We report a case of dyspnea and contrast-enhanced computed tomography (CT) findings of pulmonary vein thrombosis after left upper lobectomy. Case presentation A 68-year-old man with left lung cancer underwent video-assisted thoracoscopic left upper lobectomy under general anesthesia with thoracic epidural analgesia. He had no postoperative complications and was discharged home on the 5th day postoperatively. He visited the outpatient clinic at 8 days after surgery because of dyspnea and underwent contrast-enhanced CT, which revealed a thrombus at the resected edge of the left upper pulmonary vein. Anticoagulation therapy was started. Thereafter, the thrombus shrank, and the patient’s dyspnea improved. Conclusions Left upper lobe resection is particularly associated with pulmonary venous thrombosis, and dyspnea due to pulmonary venous thrombus may develop late after surgery. Postoperative management methods such as anticoagulation and postoperative pain management should be reexamined.

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“…Thoracoscopic lobectomy is beneficial in many aspects, while postoperative complications may still occur to varying degrees. Venous thromboembolism (VTE) is a serious complication after thoracoscopic lobectomy, 8 , 9 and patients with thrombosis are at high risk of critical symptoms including pulmonary embolism, infarction, or chronic thromboembolic pulmonary hypertension. As a case report presented, a patient with LC who underwent right lower lobectomy and mediastinal lymphadenectomy developed thrombosis in the right lower lobar pulmonary artery stump three months later.…”

Section: Introductionmentioning

confidence: 99%

Risk Factor Analysis of Postoperative Venous Thromboembolism in Patients After Thoracoscopic Lobectomy

Qiao

Jiang

2023

Clin Appl Thromb Hemost

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Objective To analyze independent risk factors for postoperative venous thromboembolism (VTE) in patients after thoracoscopic lobectomy and establish a risk model for predicting thrombosis. Methods We selected 135 patients who underwent thoracoscopic lobectomy and assigned them to a VTE group ( n = 31) and a non-VTE group ( n = 104) according to the presence or absence of postoperative VTE. Univariate and multivariate logistic regression models were built to identify independent risk factors for postoperative thrombosis. A nomogram to predict the risk of thrombosis was generated, with the predictive performance of the model being evaluated by plotting calibration curve and the receiver operating characteristic (ROC) curve. Results D-dimer on the first postoperative day and Caprini scores were independent high-risk factors for VTE after thoracoscopic lobectomy as revealed by univariate and multivariate logistic regression analyses ( p < .05). The nomogram was evaluated, and the fitting degree of calibration curve indicated good accuracy of the model in predicting thrombosis. The area under the curve (AUC) value was 0.8654, suggesting favorable diagnostic efficacy of the model. Conclusion The D-dimer on the first postoperative day and Caprini scores were independent risk factors for VTE after thoracoscopic lobectomy. The nomogram that was generated to predict the risk of thrombosis had good accuracy and diagnostic efficacy, which can guide individual risk assessment and management decisions in clinical practice.

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Pulmonary vein thrombosis and cerebral infarction after video-assisted thoracic surgery of the left upper lobe: a case series

Cited by 8 publications

References 19 publications

Pulmonary vein stump thrombosis after lung resection for lung cancer: clinical features and outcome

Pulmonary vein stump thrombosis after lung resection for lung cancer: clinical features and outcome

Dyspnea after discharge from hospital due to pulmonary vein thrombosis after video-assisted left upper lobectomy: a case report

Risk Factor Analysis of Postoperative Venous Thromboembolism in Patients After Thoracoscopic Lobectomy

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