Venous Ultrasonography Research Articles

Evaluation of Lower Extremity Venous Doppler Ultrasonography Outcomes Before And After The COVID-19 Pandemic; A Retrospective Study

Objectives: COVID-19 PCR positivity has been reported among asymptomatic individuals and asymptomatic people are also considered to be at risk for thromboembolic events. The aim of this study was to compare the results of patients who underwent lower extremity Doppler ultrasonography (DUS) with a preliminary diagnosis of deep vein thrombosis (DVT) before and after the pandemic, regardless of COVID-19 PCR testing. Methods: Patients who underwent RDUS in the Department of Radiology during a total period of 35 months (01/08/2018 - 01/07/2021) were analyzed. A total of 599 patients underwent RDUS during the study period. Results: More pozitif DVT findings were observed after the pandemic (n=43, 18.3%, p=0.005) (only two of these patients had a positive COVID-19 PCR result). History of hospitalization in the last three months, D-dimer, PLT, MPV, WBC, neutrophil count, lymphocyte count, NLR values, comorbidity and antiaggregant use were not different (p>0.05). Conclusion: Even individuals (especially elderly individuals) who have been exposed to the virus during the pandemic but who do not show symptoms are at risk of DVT.

Intrarenal Vein Congestion Score but Not Venous Excess Ultrasonography Is Associated with Kidney Perfusion and Etiology of AKI

Intrarenal Vein Congestion Score but Not Venous Excess Ultrasonography Is Associated with Kidney Perfusion and Etiology of AKI

Incidence of and risk factors for preoperative deep vein thrombosis in elderly patients with end-stage osteoarthritis following total knee arthroplasty: a retrospective cohort study

BackgroundDeep vein thrombosis (DVT) is a common and serious risk in elderly patients with knee osteoarthritis (OA), making preoperative detection crucial. Despite this, identifying OA patients at high risk for preoperative DVT and appropriately targeting them for venous ultrasound screening remains a challenge. There is limited research-based evidence on the risk factors for preoperative DVT in elderly patients with end-stage OA. We examined the incidence of and risk factors for preoperative DVT in elderly patients with end-stage OA scheduled for total knee arthroplasty.MethodsWe retrospectively analyzed the demographic data (age, sex, body mass index, current smoking, alcohol consumption, walking status, and Barthel index score), medical history, and laboratory test indices of 1411 patients with end-stage OA aged ≥ 60 years scheduled for total knee arthroplasty from January 2015 to December 2018. Risk factors for preoperative DVT were evaluated by univariate and multivariate logistic analyses. Receiver operating characteristic analysis was performed to determine optimal cut-off values.ResultsThe incidence of preoperative DVT was 4.5% (63 of 1411 patients). Seven independent risk factors were correlated with preoperative DVT in the multivariate logistic regression: age (odds ratio [OR], 1.073; P = 0.002), D-dimer concentration (OR, 1.173; P = 0.003), hyperlipidemia (OR, 2.038; P = 0.045), atrial fibrillation (OR, 4.004; P = 0.033), chronic renal failure (OR, 6.732; P = 0.008), chronic obstructive pulmonary disease (COPD) (OR, 8.721; P = 0.001), and walking status (wheelchair) (OR, 2.697; P = 0.002). The optimal cut-off values for predicting preoperative DVT were 0.585 µg/mL for the D-dimer concentration (area under the curve [AUC], 0.769; P < 0.001) and 72.5 years for age (AUC, 0.668; P < 0.001).ConclusionAmong elderly patients with end-stage OA, venous ultrasonography to rule out DVT risk should be prioritized in those with a high D-dimer concentration (> 0.585 µg/mL), high age (> 72.5 years), hyperlipidemia, atrial fibrillation, chronic renal failure, COPD, and walking status (wheelchair).

Chronic thromboembolic pulmonary hypertension in acute pulmonary embolism: a risk factor evaluation study

Aims: Pulmonary thromboembolism (PTE) is a highly mortal disease, defined by presence of thrombus partially or completely obstructing pulmonary arteries and/or veins, commonly originated from deep venous system. Chronic thrombroembolic pulmonary hypertension (CTEPH) is a rare complication of PTE with high mortality if not treated properly. In recent studies, incidence of CTEPH was found between %0,4-9,1. Due to clinically silent PTE in roughly %50 of patients, it is difficult to pinpoint the exact incidence of CTEPH. In this study, we aim to investigate PTE patients during their long-term follow up to observe CTEPH presence and evaluate CTEPH risk factors. Methods: Patients who had been evaluated in emergency service and/or admitted to pulmonary medicine ward between January 2014 and January 2017 with PTE diagnosis confirmed by computed tomography pulmonary angiogram (CTPA) were accepted retrospectively into the study. Their echocardiography, CTPA and lower extremity venous Doppler ultrasonography at 3., 6. and 12. months follow up were also included. In the patient group with pulmonary arterial pressure (PAP ) above 50 mmHg and residual thrombosis at CTPA, ventilation-perfusion scintigraphy had been performed and was added to the study. Among those suitable for CTEPH, right cardiac catheterization had been done to confirm the diagnosis and accepted as CTEPH. In addition to this group, patients who were not found suitable for right cardiac catheterization but wereclinically suitable for CTEPH are also included in the CTEPH group. Results: Average age of patients included into the study was 62(±16, 5), with 71 (%39) being male and 111 (%61) female. As for risk factors, 130 (%71,4) had acquired, 16 (%8,8) had genetic and the rest 36 (%19,8) did not have any prominent risk factors. At time of diagnosis, 10 patients were accepted as massive, 26 as sub massive and the rest 139 were considered non-massive PTE. Due to hemodynamic instability, 7 (%3,8) patients were given thrombolytic therapy. During 1 year follow-up, 5 (%2,7) patients were diagnosed with CTPH. When further investigation was performed on these 5 patients, atrial fibrillation (AF), persistent thrombosis at 12. month follow up CTPA and PAP above 55 mmHg upon time of diagnosis were found significant risk factors (p being 0,001/0,023/0,009 respectively). In multivariate analysis, no independent predictive factors were found in regards to CTEPH diagnosis. Conclusion: CTEPH is a preventable complication of PTE with severe mortality and morbidity if not properly treated. It might prove useful to utilize echocardiography and CTPA together, especially in those in high risk groups, for diagnosis of patients in early stage of CTEPH with no evident signs or symptoms.

Relationship Between Diameter and Pelvic Vein Reflux

Introduction: Diameter has been a complementary measurement in the evaluation of venous valvular insufficiency of superficial veins of the lower extremity. Small veins with reflux or large veins without reflux may indicate alternative treatments. Awareness of pelvic vein reflux is increasing. The pelvic vein diameter-reflux relationship was investigated. Methods: Findings of lower extremity ultrasound (US) and/or clinical conditions—pelvic pain, dyspareunia and dysmenorrhoea—were indications for pelvic/abdominal venous US. Complete US examination included renal, internal iliac and gonadal/ovarian veins. Diameters of the largest right or left pelvic veins were compared with presence of reflux. Intravaginal US was completed in 104 women, age 46 ± 11 (standard deviation) (range 25-76) years old. Pelvic symptoms were reported by 30 (29%) patients. The other patients had pelvic-related recurrent varicose veins or suspected pelvic source of lower extremity venous reflux. Positive and negative predictive values (PPV, NPV) and other statistics at the 90-95% level were calculated relating diameter to pelvic vein reflux. Results: Pelvic vein reflux was detected in 54 (52%) women. Pelvic vein diameters were larger in refluxing, 8.4 ± 1.9 (5.1-14.0) mm, than in nonrefluxing veins, 5.2 ± 1.0 (3.4-8.3) mm ( P &lt; .001 by t test). Diameters ≥6.3 mm had 91% (49/54) sensitivity and 92% (49/53) PPV. Diameters ≤6.3 mm had 94% specificity (47/50) and 89% (47/53) NPV. All veins with diameter ≥8.4 mm ( n = 21) had reflux. All veins with diameter ≤5.0 mm ( n = 27) did not have reflux. Conclusions: Probabilities of pelvic vein reflux were estimated based on diameters. Diameter-reflux agreement solidifies diagnosis. An explanation for contradiction between small diameter and reflux or large diameter and no reflux is recommended.

Lymphedema in a patient with decompensated cirrhosis

The lymphatic system is critical in body fluid homeostasis. Although lymphatic vascular expansion prevents the development of ascites and oedema in the early stages of liver cirrhosis, compensatory mechanisms cannot achieve this in the advanced stages due to lymphatic dysfunction. A 36-year-old male patient, who had been followed up for cryptogenic cirrhosis for 15 years, had been complaining of excessive swelling in his legs for the last 4 years. Excessive swelling in the legs was accompanied by skin rashes and ulcers, and the leg skin had an orange peel appearance characteristic of lymphedema. Bilateral lower extremity artery and venous system colour Doppler ultrasonography showed that the vascular structures of the right lower extremity arterial and venous system were open, and the flow rate, direction and spectrum were normal. The patient, who could not undergo liver transplantation due to organ limitations, died due to sepsis following lymphedema-induced wound infection. In conclusion, this case suggests that lymphedema should be considered in the presence of oedema in cases of decompensated cirrhosis, and the necessary conservative treatments should be applied.

Quality of referrals for lower extremity ultrasonography and computed tomography pulmonary angiography and associations with positive findings of venous thromboembolism

IntroductionThe referral is the basis for radiologists’ assessment of modality, protocol and urgency, and insufficient information may threaten patient safety. The aim of this study was to assess the completeness of referrals for lower extremity venous duplex ultrasonography (LEVDUS) and computed tomography pulmonary angiography (CTPA), and to investigate associations between the provided clinical information including risk factors, symptoms and lab results in the referrals and positive findings of deep vein thrombosis (DVT) and pulmonary embolism (PE), respectively. MethodsReferrals for LEVDUS (801) and CTPA (800) performed from 2016 to 2019 were obtained. Three categories of clinical information from the referrals were recorded: symptoms, risk factors and laboratory results, as well as positive imaging findings of venous thromboembolism (VTE). Referral completeness was rated from zero to three according to how many categories of clinical information the referral provided. ResultsInformation from all three clinical information categories was provided in 15% and 25% of referrals for LEVDUS and CTPA, respectively, while 2% and 10% of referrals did not contain any clinical information. Symptoms were provided most often (85% for LEVDUS and 94% for CTPA). Provided information about risk factors was significantly associated with positive findings for LEVDUS, (p = 0.02) and CTPA (p < 0.001). ConclusionA great majority of referrals failed to provide one or more categories of clinical information. Risk factors were associated with a positive finding of VTE on LEVDUS and CTPA. Implications for practiceImproving clinical information in referrals may improve justification, patient safety and quality of radiology services.

Incidence and risk factors of venous thromboembolism in neurosurgical patients after implementing a screening protocol; a retrospective cohort study of a tertiary center

Introduction: Venous thromboembolism (VTE) is a common complication in neurosurgical procedures both before and after surgery. Objective: To examine the incidence of venous thromboembolism (VTE) in neurosurgical patients before surgery and in the postoperative period after implementing a VTE prophylaxis protocol. We also aimed to determine VTE risk factors. Methods: We conducted a retrospective cohort study examining 200 patients admitted to the hospital for cranial and spine neurosurgical procedures between January 2020 and October 2021. All patients were screened for VTE using a protocol combining measurement of D-dimer level and venous duplex ultrasonography. Patients who screened negative for VTE were evaluated for VTE risk using the Caprini risk assessment model; those with Caprini score ≥3 (indicating moderate-to-high risk) received VTE prophylaxis using intermittent pneumatic compression devices. Results: Preoperative screening demonstrated DVT in seven of 200 patients (3.5%). All DVTs were asymptomatic and proximal in location. Univariate logistic regression showed that stroke, neurodegenerative disease, and confinement to bed for more than 72 hours were significant predictors of preoperative DVT. Among the patients without DVT on preoperative screening, 179 (93%) had a Caprini score ≥3; intermittent pneumatic compression was used for prophylaxis in 173 of these (96.6%). Incidence of postoperative VTE was 2.6% (5/193). Extended length of hospital stay, postoperative hydrocephalus, and infection were significant risk factors for VTE. Conclusion: Preoperative VTE screening using D-dimer level and V-DUS and implementation of VTE prophylaxis using IPC can reduce the incidence of VTE and VTE-related mortality in neurosurgical patients.

Systematic review of the use of ultrasound for venous assessment and venous thrombosis screening in spaceflight

The validity of venous ultrasound (V-US) for the diagnosis of deep vein thrombosis (DVT) during spaceflight is unknown and difficult to establish in diagnostic accuracy and diagnostic management studies in this context. We performed a systematic review of the use of V-US in the upper-body venous system in spaceflight to identify microgravity-related changes and the effect of venous interventions to reverse them, and to assess appropriateness of spaceflight V-US with terrestrial standards. An appropriateness tool was developed following expert panel discussions and review of terrestrial diagnostic studies, including criteria relevant to crew experience, in-flight equipment, assessment sites, ultrasound modalities, and DVT diagnosis. Microgravity-related findings reported as an increase in internal jugular vein (IJV) cross-sectional area and pressure were associated with reduced, stagnant, and retrograde flow. Changes were on average responsive to venous interventions using lower body negative pressure, Bracelets, Valsalva and Mueller manoeuvres, and contralateral IJV compression. In comparison with terrestrial standards, spaceflight V-US did not meet all appropriateness criteria. In DVT studies (n = 3), a single thrombosis was reported and only ultrasound modality criterion met the standards. In the other studies (n = 15), all the criteria were appropriate except crew experience criterion, which was appropriate in only four studies. Future practice and research should account for microgravity-related changes, evaluate individual effect of venous interventions, and adopt Earth-based V-US standards.

Optimizing the Peripheral Venous Duplex Ultrasound Protocol to Minimize Repetitive Strain Injuries among Sonographers

Background and Objective: Peripheral venous duplex ultrasonography is the standard imaging test to assess patients with known or suspected deep vein thrombosis. The conventional protocol for the lower extremity exam may be time-consuming and ergonomically challenging, increasing the risk for repetitive strain injuries (RSIs) among sonographers. Recognizing the high demand for these ultrasounds and the impact of RSIs on sonographers, we aimed to optimize the lower extremity peripheral venous ultrasound protocol at our institution by addressing exam components that increased exam difficulty or length. Methods: To evaluate where the protocol could be appropriately shortened, we performed (1) a review of current literature, (2) a survey of sonographers, and (3) engagement with a group of radiologists. Results: It was determined that eliminating or minimizing requirements for routine augmentations and assessment of respiratory variation would have limited clinical impact while reducing exam duration and mitigating ergonomic risks associated with peripheral venous exams. Conclusion: Evaluating conventional protocols to optimize practice will help reduce burden on staff, improve efficiency, and ultimately support more effective diagnostic care.

The Importance of Venous Reflux Status Evaluation in the Intensive Care Unit.

The current management approach for critically ill patients emphasizes maintaining adequate cardiac output and mean arterial pressure. Recently, researchers have increasingly emphasized the clinical significance of venous reflux. Bedside venous Doppler ultrasonography offers continuous, dynamic, and quantifiable assessment of the venous reflux status. In this review, we explore the pertinent literature on assessing the venous reflux status in critically ill patients. We propose a bedside ultrasonographic evaluation method that starts with the hepatic veins and progresses to the portal, renal and intrarenal, femoral, and pulmonary veins. The clinical significance of venous reflux status evaluation is discussed in terms of its effect on right ventricular function, the functioning of other organs, and the guidance of fluid therapy. Overall, we underscore the importance of venous reflux status evaluation in critically ill patients and highlight the benefits of incorporating bedside ultrasonography for the continuous monitoring of venous return.

Clinical Profile and Risk Factors of Adult Patients with Deep Vein Thrombosis in a Tertiary Hospital

Background: Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is a pressing problem in developing countries like the Philippines. There is a need to investigate the clinical profile of DVT patients to recognize those requiring considerate attention to prevent complications. Objectives: To determine the Clinical Profile of Adult Patients with Deep Vein Thrombosis in University of Santo Tomas Hospital from October 2015- June 2017. Methods: Retrospective cross sectional study was done. All adult patients who underwent venous duplex ultrasonography in the University of Santo Tomas Hospital from October 2015- June 2017 were identified and their data retrieved using the Heart Station computer database. Results: Out of the 290 patients, 45 (15.5%; 95%CI: 11.5 – 20.2%) were positive for DVT. Age (p=0.694) and gender (p=0.494) did not differ among those with and without DVT. The highest incidence is among those in the age range of 61-80 years old. The trend increased according to age up to 80 years old, beyond which there is a noted decline. The following were identified as significant risk factors in DVT: history of DVT (p&lt;0.001), malignancy (p&lt;0.001), recent surgery (p 0.02), oral contraceptive use (p 0.018) and bedridden state (p&lt;0.001). Edema was the most common presentation. Conclusion: Among those who underwent venous duplex ultrasound of the lower extremities, 15% of the population had findings consistent with DVT, the mean age is 62.6 years old. In this study, we concluded that the most significant risk factors include malignancy, bedridden state, OCP use and recent surgery.

Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

AbstractFat embolism (FES) is a condition that can lead to severe organ effects and death in patients with long bone fractures. Diagnosis is challenging due to multiple criteria. This case report presents the use of point‐of‐care ultrasound (POCUS) in diagnosing right ventricular dysfunction associated with fat embolism syndrome. A 36‐year‐old patient with a history of obesity presented with multiple fractures and respiratory failure after a road accident. Bedside echocardiography showed evidence of dilated right chambers, right ventricular outflow tract shortened acceleration time, and mild tricuspid insufficiency. Venous ultrasonography showed microembolic signals (MES) interpreted as fat embolism. The patient was treated with fracture reduction and osteosynthesis, which showed improvement in right ventricular dysfunction and the disappearance of MES. FES is a clinical syndrome that occurs after an identifiable bone injury. This case highlights the utility of POCUS in the diagnosis of FES.

A comprehensive deep venous thrombosis prophylaxis regimen in isolated coronary artery bypass grafting

ObjectivesDeep venous thrombosis (DVT) is a known surgical complication that can lead to pulmonary embolism with subsequent morbidity and mortality. The incidence of DVT following coronary artery bypass grafting is unclear. Prophylaxis regimens vary and some guidelines advocate against use of routine chemoprophylaxis in patients at low-moderate risk for venous thromboembolism. We utilized postoperative lower extremity venous ultrasound to determine the incidence of DVT following coronary artery bypass grafting in patients with low- to moderate-risk of venous thromboembolism receiving aggressive postoperative DVT prophylaxis. MethodsThis is a single-center, retrospective study of all patients who underwent coronary artery bypass grafting between April 2022 and January 2023. All patients who completed postoperative venous ultrasound of the bilateral lower extremities were initially included. Patients who underwent concurrent valve or aortic surgery, were at high risk of venous thromboembolism, or were receiving anticoagulation therapy for nonvenous thromboembolism indications were excluded. The primary outcome was in-hospital incidence of DVT. Secondary outcomes were rates of mortality, postoperative bleeding, and thromboembolic events from discharge to 30 days postoperatively and from 30 days to 3 months postoperatively. ResultsNo DVTs were observed in 211 included patients. In hospital, there were 3 significant bleeding events and 1 stroke. Following discharge there were 3 additional bleeding events, 1 death, 1 transient ischemic attack, and 1 pulmonary embolism. ConclusionsWe observed a 0% rate of DVT in low- to moderate-risk patients undergoing isolated coronary artery bypass grafting and receiving a comprehensive DVT prophylaxis regimen. In hospital bleeding and other thromboembolic event rates were 2.84% and 0.47% respectively.

Incidence and risk factors of venous thromboembolism in kidney transplantation patients: a prospective cohort study.

To investigate the incidence and explore the risk factors of venous thromboembolism (VTE) within 6months after kidney transplantation. Total of 331 kidney transplant recipients were assessed by venous ultrasonography for VTE at 14days, 1month, 3months, and 6months post-transplantation. Cox forward regression were used to identify the independent risk factors of VTE. This study registration number is ChiCTR1900020567 and the date of registration was 2019/01/08. The cumulative incidence of VTE was 2.72% (9/331) within 6months after transplant. 77.8% (7/9) of VTEs occurred in the first 3months post-transplantation. 88.9% (1/9) of VTEs were asymptomatic, 66.7% (6/9) of VTEs were mural thromboses and in the right lower extremity. Central vena catheterization (HR = 6.94) and severe pulmonary disease (including pneumonia) (HR = 57.35) were the risk factors for VTE in kidney transplantation recipients. KT patients are the high risk population of VTE. Future interventions should be strengthen for KT patients to receive a minimum of 3-month of precautionary measures for VTE, including infection prevention, and strengthening thromboprophylaxis on the CVC or transplanted side of lower extremity.

Caprini risk assessment model combined with D-dimer to predict the occurrence of deep vein thrombosis and guide intervention after laparoscopic radical resection of colorectal cancer

BackgroundTo explore the diagnostic value of Caprini risk assessment model (2005) combined with D-dimer for deep vein thrombosis, and to exclude patients with low incidence of thrombosis who might not need anticoagulation after surgery.MethodsA total of 171 colorectal cancer patients who underwent surgery from January 2022 to August 2022 were enrolled in this study. Caprini risk assessment model was used to evaluate patients the day before surgery, and full-length venous ultrasonography of lower extremity was used to assess whether patients had thrombosis one day before surgery and the sixth day after surgery. The value of D-dimer was measured by enzyme-linked immunosorbent assays on the first day after surgery, and clinical data of patients were collected during hospitalization.ResultsA total of 171 patients were divided into IPC Group and IPC + LMWH Group according to whether low molecular weight heparin (LMWH) were used to prevent thrombus after surgery. Eventually, 17.6% (15/85) patients in IPC Group and 7% (6/86) patients in IPC + LMWH Group developed DVT. Through separate analysis of IPC Group, it is found that Caprini score and D-dimer were independent risk factors for DVT (Caprini OR 3.39 [95% CI 1.38–8.32]; P = 0.008, D-Dimer OR 6.142 [95% CI 1.209–31.187]; P = 0.029). The area under ROC curve of Caprini risk assessment model is 0.792 (95% CI 0.69–0.945, P < 0.01), the cut-off value is 9.5, and the area under ROC curve of D-dimer is 0.738 (95%CI 0.555–0.921, P < 0.01), the cut-off value is 0.835 μg/mL, and the area under the ROC curve was 0.865 (95% CI 0.754–0.976, P < 0.01) when both of them were combined. Based on decision curve analysis, it is found that Caprini risk assessment model combined with D-dimer can benefit patients more. All patients are divided into four groups. When Caprini score < 10 and D-dimer < 0.835 μg/mL, only 1.23% (1/81) of patients have thrombosis and LMWH has little significance. When Caprini score > 10 and D-dimer > 0.835 μg/mL, the incidence of DVT is 38.7% (12/31) and LMWH should be considered.ConclusionsThe Caprini risk assessment model and D-dimer can provide more accurate risk stratification for patients after laparoscopic radical resection of colorectal cancer.

The relationship between pes planus and venous insufficiency.

The presence of pes planus may be responsible for the disorder of venous return during ambulation. Our aim in this study is to reveal that the risk of venous insufficiency may be increased in patients with pes planus. A total of 59 patients with 29 bilateral pes planus and 30 normal arches included in the study. Djian Annonier angle measurement, bilateral lower extremity venous Doppler ultrasonography (USG), foot function index (AFI), Comprehensive Classification System for Chronic Venous Disorders (CEAP) clinical scoring and Short Form-36 (SF-36) was evaluated. There was a statistically significant difference in AFI total, AFI pain, AFI disability and AFI activity limitation scores, bilateral lower extremity doppler USG and CEAP clinical scores in the patient group compared to the control group. These findings suggest that there may be a relationship between pes planus and venous insufficiency. However, large-scale studies with more patient involvement are needed.

Preoperative D-dimer Value and Lower Limb Venous Ultrasound for Deep Venous Thrombosis Prevents Postoperative Symptomatic Venous Thromboembolism in Patients Undergoing Colorectal Surgery: A Retrospective Study.

Preoperative deep venous thrombosis (DVT) can cause potentially life-threatening postoperative venous thromboembolism (VTE). Lower limb venous ultrasound (LLVU) is a modality that can detect DVT. However, the threshold for performing preoperative LLVU in the population undergoing colorectal resection is controversial. In this context, we evaluated whether a preoperative D-dimer value can identify patients who benefit from LLVU from the perspective of preventing postoperative symptomatic VTE. Patients undergoing colorectal resection in our institute from 2013 to 2020 were retrospectively enrolled (n=2071). We divided the patients into two groups: the clinical indication group (CG: including patients from 2013 to 2016, n=875) and the D-dimer-orientated group (DG: including patients from 2017 to 2020, n=1196). In the CG, LLVU was performed when DVT was clinically suspected; in the DG, preoperative LLVU was performed in patients with a preoperative D-dimer>1.0 μg/ml. In the surveyed period, 277 LLVUs were performed, among which DVT was detected in 34 cases (12.3%). In the CG, DVT was detected in 0.7% of patients, whereas in the DG, it was detected in 2.3% of patients. Postoperative symptomatic VTE was significantly reduced in the DG at both 3 and 6 months after surgery (p=0.041 and 0.020, respectively). Moreover, Multivariate analysis showed that a past medical history of PE and treatment following the CG protocol were independent risk factors for postoperative symptomatic VTE within 6 months of surgery (p<0.0001 and =0.036, respectively). LLVU in patients with a preoperative D-dimer>1.0 μg/ml is a useful method to prevent postoperative symptomatic VTE.

Optimal D-Dimer Cutoff Values for Diagnosing Deep Vein Thrombosis in Patients with Comorbid Malignancies

Patients with malignancy are at high risk of venous thromboembolism, and early diagnosis is important. The Khorana score is known as a risk assessment for cancer-related thrombosis during chemotherapy, but there are still few reports on its diagnostic potential, the optimal D-dimer cutoff values for indications other than chemotherapy and the use of the Khorana score in combination with D-dimers. In this study, we examined the clinical appropriateness of increasing the D-dimer cutoff value. We retrospectively studied 208 malignancies out of 556 patients who underwent lower extremity venous ultrasonography at our hospital over a 2-year period from January 2018 to December 2019. The optimal D-dimer cutoff value for predicting deep vein thrombosis (DVT) in patients with malignancy was calculated by the Youden index. The usefulness of the Khorana score alone and the model combining the Khorana score with D-dimer for predicting DVT diagnosis was compared using receiver operating characteristic analysis. Of 208 eligible patients, 59 (28.4%) had confirmed DVT. The optimal D-dimer cutoff value for predicting DVT comorbidity in patients with malignancy was 3.96μg/mL. When the new D-dimer cutoff value was set at 4.0μg/mL, the odds ratio (OR) for DVT diagnosis was 4.23 (95% confidence interval (CI) 2.10-8.55, P<0.001), which was higher than the OR of 1.33 (95% CI: 0.98-1.81, P=0.064) for the Khorana score. The area under the curve for the Khorana score and D-dimer was 0.714, which was significantly higher than the 0.611 for the Khorana score alone, with the difference being significantly higher at 0.103 (P=0.004, 95% CI: 0.033-0.173). The optimal D-dimer cutoff value for the diagnosis of DVT in patients with malignancy was 4.0μg/mL. It was also suggested that the combination of the Khorana score with the D-dimer level was more accurate in diagnosing DVT than the Khorana score alone.

Prevalence of preoperative asymptomatic deep vein thrombosis in patients undergoing elective general surgery for benign disease.

The systemic inflammatory response following surgery as well as that of malignant disease itself is associated with a hypercoagulable state, and thromboprophylaxis is thus recommended during postoperative management of cancer patients. However, limited information is available on the prevalence of preoperative deep vein thrombosis (DVT) and its risk factors in surgical candidates, especially those receiving operations for benign diseases. This is a retrospective observational study with data of all patients scheduled for elective general surgery between January 2011 and September 2020, undergoing lower extremity venous ultrasonography as preoperative screening for DVT. The prevalence of preoperative asymptomatic DVT was estimated and its associations with clinical variables were evaluated. Among 1512 patients included in the study, 161 (10.6%) had asymptomatic DVT before surgery. DVT prevalence was 13.7% in patients with malignant disease, while it was 8.6% in those with benign disease. The site of the thrombus was distal type in 141 (87.6%) patients, most commonly in the soleal vein. Advanced age (>70 years), female sex, and decreased hemoglobin level were significantly associated with preoperative asymptomatic DVT by multivariate analysis. The odds ratio for advanced age was the highest and rose as age increased. Malignant disease was not an independent risk factor for preoperative DVT. This study showed the prevalence of asymptomatic DVT to be equal in patients with and without malignant disease undergoing elective general surgery. Preoperative DVT assessment is necessary regardless of the disease indicated for surgery, especially in patients with the risk factors identified in this study.