Caitlin W Hicks1, Natalia O Glebova2, Kristen M Piazza1, Kristine Orion3, Phillip M Pierorazio4, Ying Wei Lum1, Christopher J Abularrage1, James H Black5. 1. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md. 2. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md; Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, Colo. 3. Section of Vascular Surgery, Yale School of Medicine, New Haven, Conn. 4. James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Hospital, Baltimore, Md. 5. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md. Electronic address: jhblack@jhmi.edu.
Abstract
OBJECTIVE: The perioperative risk of an acute venous thromboembolism (VTE) event after inferior vena cava (IVC) reconstruction is unknown. We sought to describe VTE outcomes of our 15-year IVC reconstruction experience. METHODS: We performed a retrospective institutional review of all patients who underwent IVC reconstruction (September 1999-October 2014) and describe perioperative VTE outcomes. RESULTS: Sixty-five patients (mean age 58 ± 2 years) underwent IVC reconstruction (primary repair, 25%; patch, 43%; graft, 32%), most commonly for renal cell carcinoma (51%) and retroperitoneal sarcoma (22%). The overall incidence of perioperative VTE was 22% (n = 14), including isolated deep vein thrombosis (DVT) in 9% (n = 6) and pulmonary embolism in 12% (n = 8; 4 with concomitant DVT). Median time to diagnosis was 6 days (range, 1-37 days). Most VTE patients were symptomatic (57%; 8 of 14), including lower extremity edema in 50%, acute desaturation in 43%, and hemodynamic compromise in 36%. No patient died as a result of his or her VTE. There was a trend for more overall VTE events in patients who underwent graft reconstruction (primary, 13%; patch, 18%; graft, 33%; P = .06). VTE was also significantly associated with larger tumor size, renal vein reimplantation, and blood transfusions (P ≤ .05). Late complications of VTE included lower extremity edema in two patients and graft thrombosis in one patient. CONCLUSIONS: IVC reconstruction can be performed safely with low VTE-associated morbidity. Routine anticoagulation might not be warranted in these patients, but early postoperative screening for DVT should be considered, especially in cases with large tumor burden or when graft reconstruction is performed.
OBJECTIVE: The perioperative risk of an acute venous thromboembolism (VTE) event after inferior vena cava (IVC) reconstruction is unknown. We sought to describe VTE outcomes of our 15-year IVC reconstruction experience. METHODS: We performed a retrospective institutional review of all patients who underwent IVC reconstruction (September 1999-October 2014) and describe perioperative VTE outcomes. RESULTS: Sixty-five patients (mean age 58 ± 2 years) underwent IVC reconstruction (primary repair, 25%; patch, 43%; graft, 32%), most commonly for renal cell carcinoma (51%) and retroperitoneal sarcoma (22%). The overall incidence of perioperative VTE was 22% (n = 14), including isolated deep vein thrombosis (DVT) in 9% (n = 6) and pulmonary embolism in 12% (n = 8; 4 with concomitant DVT). Median time to diagnosis was 6 days (range, 1-37 days). Most VTEpatients were symptomatic (57%; 8 of 14), including lower extremity edema in 50%, acute desaturation in 43%, and hemodynamic compromise in 36%. No patient died as a result of his or her VTE. There was a trend for more overall VTE events in patients who underwent graft reconstruction (primary, 13%; patch, 18%; graft, 33%; P = .06). VTE was also significantly associated with larger tumor size, renal vein reimplantation, and blood transfusions (P ≤ .05). Late complications of VTE included lower extremity edema in two patients and graft thrombosis in one patient. CONCLUSIONS: IVC reconstruction can be performed safely with low VTE-associated morbidity. Routine anticoagulation might not be warranted in these patients, but early postoperative screening for DVT should be considered, especially in cases with large tumor burden or when graft reconstruction is performed.
Authors: Alex B Blair; Bradley N Reames; Jasvinder Singh; Faiz Gani; Heidi N Overton; Robert J Beaulieu; Ying W Lum; James H Black; Fabian M Johnston; Nita Ahuja Journal: J Surg Oncol Date: 2018-06-07 Impact factor: 3.454