Abstract 15281: Soleal Vein Diameter Determined by Ultrasonography is an Independent Predictor of Deep Vein Thrombosis After Major Orthopedic Surgery
Introduction: Deep vein thrombosis (DVT) develops after major orthopedic surgery despite the current use of prophylaxis. Most DVTs are developed in soleal vein (SV) and might develop easily at the site of increased SV diameter because of be blood flow stasis. However, whether SV diameter determined by ultrasonography (US) is applicable for prediction of the DVT after the major orthopedic surgery remains unknown.
Hypothesis: We examined whether SV diameter determined by US predicts the DVT after the major orthopedic surgery.
Methods: US was performed pre- (mean 5 days) and postoperatively (mean 9 days) in 108 osteoarthritic patients (age 67 ± 13 years, 79% women) who underwent major orthopedic surgery, including total hip arthroplasty (THA) (n = 81) and total knee arthroplasty (TKA) (n = 27). The patients with preoperative DVT were not included. Presence of DVT was diagnosed by US, which was performed from the bilateral femoral to lower limb. SV diameter was defined as maximal SV diameter in bilateral lower limb. All patients received postoperative mechanical thromboprophylaxis with chemical thromboprophylaxis.
Results: Thirty two patients (30%) developed the distal DVT after the major orthopedic surgery. SV diameter in DVT group was significantly larger than that in non-DVT group (8.7 ± 2.7 vs. 7.2 ± 2.0 mm, p<0.01). In univariate analysis, SV diameter (odds ratio [OR]: 1.3, p = 0.005) was the predictor of postoperative DVT, though association of the postoperative DVT with age, gender (p = 0.06), TKA (p = 0.15) or plasma D-dimer value (p = 0.24) was not significant. Multivariate logistic regression analysis indicated that SV diameter (OR: 1.3, 95% CI 1.1 to 1.6, p = 0.004) independently predicts postoperative DVT. ROC analysis indicated that optimal cutoff value of SV diameter for prediction of postoperative DVT was 8.5 mm, of which sensitivity and specificity were 56% and 79% (area under the ROC curve: 0.67), respectively.
Conclusions: SV dilatation determined by US is an independent predictor of the DVT after the major orthopedic surgery, even in the situation with both mechanical and chemical thromboprophylaxis. Assessment of the SV diameter by US is useful for identifying patients with high risk for the DVT after the major orthopedic surgery.
Author Disclosures: S. Yuda: None. K. Abe: None. K. Yasui: None. A. Hashimoto: None. A. Teramoto: None. S. Nagoya: None. T. Yamashita: None. S. Takahashi: None. T. Miura: None.
- © 2016 by American Heart Association, Inc.