Abstract 14779: Soleal Vein Dilatation Assessed by Ultrasonography is an Independent Predictor for Deep Vein Thrombosis After Total Hip Arthroplasty

Abstract

Introduction: Deep vein thrombosis (DVT) develops after lower limb arthroplasty despite the current use of prohylaxis. Thus, accurate risk stratification is warranted to establish new prophylactic strategies. Soleal vein (SV) dilatation is often found by ultrasonography, which is performd for the screeing of the DVT. However, if the SV dilatation is usable for prediction of the DVT after the lower limb arthroplasty remains unclear. Hypothesis: We aimed to examine whether the SV dilatation assessed by ultrasonography predicts the DVT after the lower limb arthroplasty. Methods: Ultrasonography was performed pre- (mean 5 days) and postoperatively (mean 8 days) in 135 osteoarthritic patients (age 66+/-13 years, 76% women) who underwent total hip arthroplasty (THA; n = 99) or knee arthroplasty (TKA; n = 36). The patients with preoperative DVT were excluded. Presence of DVT was diagnosed by ultrasonography, which was performed from the bilateral femoral to lower limb. Increased diameter of SV (>10 mm) assessed by ultrasonography was defined as the SV dilatation. Results: Thirty seven patients (27%) developed the DVT, which was proximal in one (3%) and distal in 36 (97%), after the lower limb arthroplasty. SV dilation was observed in 14 patients (10%). Of these, 11 (79%) had the postoperative DVT. Multivariate logistic regression analysis indicated that age (odds ratio [OR] 1.1, 95% CI 1.01 to 1.11, p=0.016), female (OR 4.9, 95% CI 1.18 to 19.9, p=0.028), TKA (OR 2.7, 95% CI 1.01 to 7.37, p=0.047), and SV dilatation (OR 18.8, 95% CI 4.0 to 88.8, p<0.001), but not presence of comorbidities, medications, operative time, plasma D-dimer value, independently predict postoperative DVT in the whole studied patients. Subgroup analyses according to the operation site demonstrated that the SV dilation was an independent predictor of postoperative DVT in the THA group (OR 11.1, 95% CI 2.1 to 59.0, p<0.01), however, not in the TKA group. Conclusions: In addtion to well-known risk factors for postoperative DVT, the SV dilatation assessed by ultrasonography is an independent predictor of the DVT after the THA. Assessment of the SV diameter by ultrasonography is useful for identfying patients with high risk for the postoprtative DVT after the THA.