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Abstract

We greatly appreciate the opportunity to reply to this well-formulated Letter to the Editor. Deep vein thrombosis (DVT) is a frequent clinical sequela of the femoral vein harvest (FVH) procedure. In our study, we observed a high rate of DVT after FVH only in patients with cancer. Also, DVTs proximal to the FVH segment were observed only in patients with cancer. Thus, our recommendation for prophylactic low-molecular-weight heparin in the postoperative period was for these patients with cancer to prevent DVT proximal to the harvested femoral vein. The majority of DVTs occurring after FVH were diagnosed in the retained popliteal vein stump, as correctly pointed out by the authors in the Letter to the Editor. In our study, the incidence of retained venous stump DVT was significantly lower in patients without cancer (10% vs 52%). We agree that limited information is available about the clinical consequence of DVT in the popliteal vein stump. The study by Wells et al,1Wells J.K. Hagino R.T. Bargmann K.M. Jackson M.R. Valentine R.J. Kakish H.B. et al.Venous morbidity after superficial femoral-popliteal vein harvest.J Vasc Surg. 1998; 29: 282-291Abstract Full Text Full Text PDF Scopus (97) Google Scholar in which 16 limbs with thrombus in the retained popliteal vein segment after FVH were compared with 70 limbs without DVT, provides some insight. Over a mean follow-up period of 3 years, they did not observe any additional morbidity in limbs with popliteal DVT compared with limbs without DVT. In that study, none of the patients were treated for DVT in retained popliteal segment.1Wells J.K. Hagino R.T. Bargmann K.M. Jackson M.R. Valentine R.J. Kakish H.B. et al.Venous morbidity after superficial femoral-popliteal vein harvest.J Vasc Surg. 1998; 29: 282-291Abstract Full Text Full Text PDF Scopus (97) Google Scholar Given these limited data, we do not routinely treat DVT distal to the FVH site. It is always ideal to prevent a DVT, even one with questionable clinical consequence. However, the optimal method for preventing a popliteal DVT after FVH is uncertain. Therapeutic anticoagulation is one option. However, in patients without cancer, most of whom do not develop DVT in the distal vein segment, giving therapeutic anticoagulation in the immediate postoperative period would expose most of them to the risks of anticoagulation with minimal benefit. Moreover, the duration of therapeutic anticoagulation to prevent popliteal DVT after FVH is somewhat arbitrary. Based on our data, a significant number of DVTs were diagnosed more than 10 days after the procedure. Thus, administering therapeutic anticoagulation for the first 10 days (as suggested by the authors) may not prevent a significant proportion of DVTs in the retained popliteal vein stump. Given the low incidence of popliteal DVT in patients without cancer, it is difficult to justify therapeutic anticoagulation in this population, especially when the clinical consequence of DVT in the distal popliteal vein is minimal. It is an interesting proposition to investigate the role of therapeutic anticoagulation in cancer patients who require an FVH procedure to prevent DVT proximal to the harvest site. Regarding “Symptomatic venous thromboembolism after femoral vein harvest”Journal of Vascular SurgeryVol. 57Issue 1PreviewWe read with great interest the article by Dhanisetty et al,1 which reports a high 29% incidence of venous thromboembolism (VTE) after femoral vein harvest (FVH), with the vast majority of cases (16/17) being ipsilateral deep vein thrombosis distal to the FVH site. Interestingly, in their discussion, Dhanisetty et al suggested that therapeutic anticoagulation is not indicated immediately postoperatively in patients who undergo FVH; rather, they advocated prolonged prophylaxis with low-molecular-weight heparin (LMWH). Full-Text PDF Open Archive