Eric Swanson1. 1. Dr Swanson is a plastic surgeon in private practice in Leawood, Kansas.
Abstract
BACKGROUND: Venous thromboembolism is a serious surgical complication. Risk stratification does not reliably predict which patients will be affected, and anticoagulants introduce additional risks. The Doppler ultrasound scan is the definitive test for the detection of deep vein thrombosis. OBJECTIVES: This prospective, controlled study was undertaken to determine the feasibility of Doppler ultrasound imaging as a screening tool for deep vein thromboses in plastic surgery outpatients. METHODS: Doppler ultrasound screening was offered to 100 consecutive outpatients undergoing a variety of cosmetic plastic surgeries. Total intravenous anesthesia was administered by propofol infusion, and a laryngeal mask airway was inserted. SAFE (spontaneous breathing, avoid gas, face up, and extremities mobile) principles were observed. No patient received anticoagulants. Ultrasound scans were performed before surgery, 1 day after surgery, and approximately 1 week after surgery. Deep veins of the lower extremities, including the calf veins, were analyzed by compression, color Doppler imaging, and Doppler waveform analyses. Twenty-five control participants who did not undergo surgery were evaluated with ultrasonography. A survey was administered to all participants after the scans. RESULTS: No thromboses were detected in the outpatient or control group. Few survey respondents reported discomfort during the scan, and most indicated that ultrasound scans are a valuable screening tool for blood clots. CONCLUSIONS: Doppler ultrasound imaging of the lower extremities is a valuable, noninvasive method for detecting deep venous thromboses in plastic surgery outpatients. Additional study of this modality is warranted. LEVEL OF EVIDENCE 2: Diagnostic.
BACKGROUND:Venous thromboembolism is a serious surgical complication. Risk stratification does not reliably predict which patients will be affected, and anticoagulants introduce additional risks. The Doppler ultrasound scan is the definitive test for the detection of deep vein thrombosis. OBJECTIVES: This prospective, controlled study was undertaken to determine the feasibility of Doppler ultrasound imaging as a screening tool for deep vein thromboses in plastic surgery outpatients. METHODS: Doppler ultrasound screening was offered to 100 consecutive outpatients undergoing a variety of cosmetic plastic surgeries. Total intravenous anesthesia was administered by propofol infusion, and a laryngeal mask airway was inserted. SAFE (spontaneous breathing, avoid gas, face up, and extremities mobile) principles were observed. No patient received anticoagulants. Ultrasound scans were performed before surgery, 1 day after surgery, and approximately 1 week after surgery. Deep veins of the lower extremities, including the calf veins, were analyzed by compression, color Doppler imaging, and Doppler waveform analyses. Twenty-five control participants who did not undergo surgery were evaluated with ultrasonography. A survey was administered to all participants after the scans. RESULTS: No thromboses were detected in the outpatient or control group. Few survey respondents reported discomfort during the scan, and most indicated that ultrasound scans are a valuable screening tool for blood clots. CONCLUSIONS: Doppler ultrasound imaging of the lower extremities is a valuable, noninvasive method for detecting deep venous thromboses in plastic surgery outpatients. Additional study of this modality is warranted. LEVEL OF EVIDENCE 2: Diagnostic.