RESUMEN
Virchow's triad of venous stasis, vessel wall damage, and hypercoagulability cites three factors that predispose to the formation of venous thrombosis. The pneumoperitoneum created during laparoscopic surgery results in an intraabdominal pressure that exceeds the pressure of venous blood return from the legs. This may alter venous hemodynamics enough to result in venous stasis in the legs, thus increasing the risk of thrombus formation. Duplex ultrasound was used to measure the diameter and venous flow volume of the common femoral vein during laparoscopic cholecystectomy. Measurements were obtained at three different times: after induction of anesthesia but prior to creation of pneumoperitoneum, during pneumoperitoneum, and after abdominal deflation but prior to reversal of anesthesia. After insufflation of the abdomen, the mean cross-sectional area of the common femoral vein increased (0.83 to 1.15 cm2; p = 0.0024) and the venous flow decreased (11.00 to 6.06 cm3/sec; p = 0.0008). After deflation of the abdomen, there was no significant change in cross-sectional area of the common femoral vein, but there was an increase in venous flow (6.06 to 9.94 cm3/sec; p = 0.0005). Abdominal insufflation during laparoscopic cholecystectomy results in dilation of and decreased flow in the common femoral vein. After deflation of the abdomen, flow in the vein returns to baseline levels.
Asunto(s)
Colecistectomía Laparoscópica , Complicaciones Intraoperatorias/fisiopatología , Tromboflebitis/fisiopatología , Insuficiencia Venosa/fisiopatología , Presión Venosa/fisiología , Adulto , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Femenino , Vena Femoral/diagnóstico por imagen , Vena Femoral/fisiopatología , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neumoperitoneo Artificial , Factores de Riesgo , Tromboflebitis/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Insuficiencia Venosa/diagnóstico por imagenRESUMEN
An 82-year-old man was admitted with a left hip fracture sustained in a fall. The fracture was surgically repaired. Ipsilateral leg swelling developed over the following 2 weeks. A lower extremity venous duplex scan demonstrated isolated dilatation of the popliteal veins in both lower extremities. Chronic thrombosis was noted in both popliteal veins at the level of this dilatation. Initial duplex scanning also revealed acute thrombus in the left popliteal, posterior tibial, and peroneal veins. A repeat scan 1 week later identified propagation of thrombus into the superficial femoral vein. Popliteal vein aneurysms, although rare, can cause significant morbidity and mortality. The literature is also reviewed.
Asunto(s)
Aneurisma , Vena Poplítea , Anciano , Anciano de 80 o más Años , Aneurisma/diagnóstico por imagen , Aneurisma/patología , Humanos , Masculino , Vena Poplítea/diagnóstico por imagen , UltrasonografíaRESUMEN
Forty-three consecutive patients with greater saphenous vein (GSV) thrombosis extending to the saphenofemoral junction (SFJ) were treated. Twenty-three patients had extension of thrombus into the common femoral vein (CFV). Twenty patients had thrombus extending to but not within the CFV. Symptoms, risk factors, and physical examination were not predictive of CFV thrombus extension. When compared with the operative record, duplex scans accurately located the extent of the thrombosis 100% of the time. Forty-one surgical procedures were performed. No patients had pulmonary emboli during the procedures. Thirty-seven patients were treated as outpatients or were discharged within 3 days of their surgical procedures. The two patients who did not undergo operative procedures in this series had complete occlusion of the CFV with extension into the external iliac vein. Thrombus within 3 cm of the SFJ is an indication for surgical intervention. Disconnection of the GSV from the CFV prevents extension of the thrombus, and a limited CFV thrombectomy can be performed when necessary. This is considerably more cost-effective than treatment with anticoagulation.