The effect of increased hip flexion using stirrups on lower-extremity venous flow: a prospective observational study

Abstract

Background Patient positioning during operations for colorectal cancer may represent an unrecognized risk factor for deep venous thrombosis. Methods Twelve healthy control patients were positioned supine with knee flexion at 90°. Duplex ultrasound examined common femoral vein (CFV) and proximal femoral vein (PFV) diameter, peak systolic velocity, and volume-flow with hip flexion at 0°, 30°, 60°, and 90°. Data were analyzed using the paired t-test. Results In the CFV, hip flexion to 90° was associated with significant increase in mean volume-flow when compared to hip flexion at 0° (0.59 L/min vs. 0.36 L/min, p=0.05) and 30° (0.59 L/min vs. 0.35 L/min, p=0.038). In both the CFV and PFV, increased hip flexion was associated with significantly reduced vessel diameter and increased peak systolic velocity. Conclusions Intra-operative positioning of the lower extremities represents a modifiable risk factor for deep venous thrombosis. When stirrups are used, hip flexion of 90° maximizes venous drainage from the legs.

Preoperative Femoral Vein Velocity in Maximal Flexion Is a Predictor of Deep Vein Thrombosis in Patients Undergoing Total Hip Arthroplasty

“…in a study of laparoscopic and open gastric bypass surgery, it was also shown that surgical positions of the patient could lead to vein stasis 11 . in 12 healthy men aged 20-50 years who were positioned in colorectal surgery positions with 0º, 30º, 60º, 90º of hip flexion and abduction, the diameter of proximal femoral vein was shown to become smaller as the hip flexion advanced, leading to increase in femoral vein flow velocity 17 . These findings partially disagree with our results because our data demonstrated that the diameter of femoral vein was decreasing and flow velocity getting faster as the hip was more flexed at 30-60º position.…”

Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis

“…In this context, it was shown that the flow of CFV was significantly reduced during intraperitoneal insufflation, but not during preperitoneal insufflation [16]. Recently, the behavior of femoral venous flow in other types of open surgery has also been investigated [17,18]. Finally, it is interesting to know how epidural anesthesia compensates for the reduction of femoral flow detected when the laparoscopic technique is carried out under general anesthesia [19].…”

Effects of patient position on lower extremity venous pressure during different types of hysterectomy

“…Peter et al . demonstrated that hip flexion of 90° maximizes venous drainage from the legs . VTE prophylaxis guidelines in plastic surgery issued by the American Society of Plastic and Reconstructive Surgeons also reported that knee flexion of 5° can maximize popliteal venous flow .…”

“…The formation of CO 2 pneumoperitoneum during laparoscopic surgery is transmitted to the retroperitoneum, inferior caval vein and iliac veins, leading to slower flow in veins of the lower extremities. Increased chest pressure also has been observed, which could affect cardiac filling, thus in turn impeding venous flow, inducing venous stasis, and activating coagulation and fibrinolysis …”

“…Increased chest pressure also has been observed, which could affect cardiac filling, thus in turn impeding venous flow, inducing venous stasis, and activating coagulation and fibrinolysis. [7][8][9] Carbon dioxide pneumoperitoneum or the position itself are an independent risk factors for venous stasis. 10 However, in order to provide excellent vision during surgery and a convenient field for operation, use of CO2 pneumoperitoneum and position changes are always required.…”