Thrombophilia and Preoperative Deep Venous Thrombosis and Their Effect on Free Flap Survival: A Scoping Review

2021 ◽  
pp. 229255032110248
Author(s):  
Ahmed Hagiga ◽  
Mariia Gultiaeva ◽  
Lorraine E. Harry
Keyword(s):  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Free Flap ◽  
Scoping Review ◽  
Screening Tools ◽  
Preoperative Screening ◽  
Flap Survival ◽  
Flap Failure ◽  
Free Flap Surgery

Background: A proper preoperative planning is essential to prevent flap failure. However, venous workup for flaps has not been commonly performed or utilized as a preoperative screening tool. A scoping review was conducted to explore preoperative venous system screening, including deep vein thrombosis diagnosis, and its effect on flap survival rate. This review identified existing gaps of knowledge and emphasized potential research areas for future studies. Methods: Two independent reviewers searched 3 electronic databases from inception to September 2020. Retrieved appropriate articles were selected systematically by title, abstract, and full review of the article. Studies were included if they enrolled patients who had thrombophilia or deep venous thrombosis (DVT) preoperatively and had undergone a free flap reconstruction. For eligible studies, the following information was extracted: basic demographics (sex, age, comorbidities), preoperative scans type, free flap type, clotting mode (causes), wound type, and flap survival. Results: Seventeen articles were found eligible for this review. Traumatic aetiology was found in 63 (33.6%) patients, while 124 (66.3%) patients had a non-traumatic aetiology. Preoperative screening for patients with non-traumatic aetiology was reported in 119 patients. In these patients, the flap survived in 107 (89.91%) patients. Four studies investigating patients with traumatic DVT aetiology, 60 patients (out of 63) had a preoperative computed tomography angiography or duplex. Those patients had 100% flap survival rates. Conclusion: Further investigations are required to identify venous thrombosis incidence in patients with non-traumatic thrombosis aetiology as this cohort of patients is at high risk of flap failure. Finally, the prognostic validity of available preoperative screening tools to identify high-risk patients should be assessed, such as imaging techniques, which would include venous duplex scanning, may prevent failure in free flap surgery.

Asymptomatic lower extremity deep venous thrombosis resulting in fibula free flap failure

2009 ◽  
Vol 119 (6) ◽  
pp. 1085-1087 ◽  
Author(s):  
Adam S. Jacobson ◽  
Azita S. Khorsandi ◽  
Daniel Buchbinder ◽  
Mark L. Urken
Keyword(s):  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Free Flap ◽  
Flap Failure ◽  
Fibula Free Flap

The Use of Indium-111 Labeled Platelet Scanning for the Detection of Asymptomatic Deep Venous Thrombosis in a High Risk Population

Orthopedics ◽  
1989 ◽  
Vol 12 (11) ◽  
pp. 1439-1443
Author(s):  
Robert S Siegel ◽  
Janice L Rae ◽  
Nancy L Ryan ◽  
Cherie Edwards ◽  
William P Fortune ◽  
...  
Keyword(s):  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
High Risk Population ◽  
Risk Population ◽  
Indium 111

scholarly journals Upper extremity deep venous thrombosis: risk factors, diagnosis, treatment

2016 ◽  
Vol 11 (1) ◽  
pp. 28-32
Author(s):  
Camelia C. DIACONU ◽  
◽  
Mădălina ILIE ◽  
Mihaela Adela IANCU ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Brachiocephalic Vein ◽  
Risk Of Death ◽  
Thrombosis Risk ◽  
Effort Thrombosis

Upper extremity deep venous thrombosis is a condition with increasing prevalence, with high risk of morbidity and mortality, due to embolic complications. In the majority of the cases, thrombosis involves more than one venous segment, most frequently being affected the subclavian vein, followed by internal jugular vein, brachiocephalic vein and basilic vein. Upper extremity deep venous thrombosis in patients without risk factors for thrombosis is called primary deep venous thrombosis and includes idiopathic thrombosis and effort thrombosis. Deep venous thrombosis of upper extremity is called secondary when there are known risk factors and it is encountered mainly in older patients, with many comorbidities. The positive diagnosis is established only after paraclinical and imaging investigations, ultrasonography being the most useful diagnostic method. The most important complication, with high risk of death, is pulmonary embolism. Treatment consists in anticoagulant therapy, for preventing thrombosis extension and pulmonary embolism.

Fibrinogen Proteolysis and Deep Venous Thrombosis (DVT)

1979 ◽  
Author(s):  
H.L. Nossel
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Fibrinopeptide A ◽  
Terminal Portion ◽  
Two Stage ◽  
Normal Individuals

Thrombin cleaves fibrinogen in a two-stage reaction first producing fibrin I (fl) and fibrinopeptide A (FPA) and then fibrin II (fill and fibrinopeptide B (FPU). FI forms thinner strands than fil, a property which may be important in the pathogenesis of thrombosis. In the initial stages of plasmin proteolysis of fibrinogen the C-terminal portion of the Aα chain and the N-terminal portion of the EB chain are removed, leaving a molecule called fragment X (X). Release of the N-termlnal peptide Bβ1-42 serves as an index of X formation, llcnco plasma FPA levels serve as an index of X formation by thrombin action and Bβ1-42 levels as an index of X formation by plasmin action. In normal individuals Bβ1-42 levels were approvimately three times higher than FPA levels. In patients with symptoms of DVT, which was confirmed by venogram, PPA levels were almost invariably elevated. Bβ1-42 levels were not significantly elevated in these patients in the absence of complicating pulmonary embolism. Initial studies on patients at high risk for DVT studied prospectively have shown signigicant elevation of the plasma FPA level and little change in the Bβ1-42 level for several days preceding the onset of DVT as indicated by 125I-fibTinogen scan and confirmed by venogram. Bβ1-42 levels became elevated several days later inassociation either with pulmonary embolism or with resolution of the thrombosis. These data suggest_ that the development of DVT is associated with and preceded by imbalance between thrombin action as indicated by plasma FPA levels and plasmin action as indicated by Bβ1-42 levels.

Detection and Prevention of Deep Venous Thrombosis

1988 ◽  
Vol 22 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Andra J. Melamed ◽  
Jeanette Suarez
Keyword(s):  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Low Dose ◽  
Diagnostic Techniques ◽  
Prior History ◽  
Dose Heparin ◽  
Prophylactic Measures ◽  
Patients At Risk ◽  
Low Dose Heparin

Deep venous thrombosis (DVT) is a significant problem in the postoperative course of high-risk patients. Risk factors that further predispose patients to DVT include obesity, age over 40 years, smoking, dehydration, and a prior history of thromboembolism. Diagnosis of DVT by physical examination and medical history is difficult; objective diagnostic techniques are often required. Considerable emphasis has been placed on the cost-effectiveness of implementing prophylactic measures in patients who are at high risk for developing DVT. Physical maneuvers attempt to reduce stasis and enhance venous return and pharmacologic approaches alter blood coagulability. The drug therapy used in preventing DVT consists of dextran, low-dose heparin, a combination of low-dose heparin and dihydroergotamine, and warfarin. Effective prophylactic regimens differ according to the type of patients at risk. Prophylactic therapy should be tailored according to the patient's disease and degree of risk.

scholarly journals Incidence of deep vein thrombosis and quality of venous thromboembolism prophylaxis

2014 ◽  
Vol 41 (1) ◽  
pp. 02-06 ◽  
Author(s):  
Alberto Okuhara ◽  
Túlio Pinho Navarro ◽  
Ricardo Jayme Procópio ◽  
Rodrigo De Castro Bernardes ◽  
Leonardo De Campos Correa Oliveira ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Risk Groups ◽  
Moderate Risk ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Very High

OBJECTIVE: to determine the incidence of deep vein thrombosis and prophylaxis quality in hospitalized patients undergoing vascular and orthopedic surgical procedures. METHODS: we evaluated 296 patients, whose incidence of deep venous thrombosis was studied by vascular ultrasonography. Risk factors for venous thrombosis were stratified according the Caprini model. To assess the quality of prophylaxis we compared the adopted measures with the prophylaxis guidelines of the American College of Chest Physicians. RESULTS: the overall incidence of deep venous thrombosis was 7.5%. As for the risk groups, 10.8% were considered low risk, 14.9%moderate risk, 24.3% high risk and 50.5% very high risk. Prophylaxis of deep venous thrombosis was correct in 57.7%. In groups of high and very high risk, adequate prophylaxis rates were 72.2% and 71.6%, respectively. Excessive use of chemoprophylaxis was seen in 68.7% and 61.4% in the low and moderate-risk groups, respectively. CONCLUSION: although most patients are deemed to be at high and very high risk for deep vein thrombosis, deficiency in the application of prophylaxis persists in medical practice.

scholarly journals The incidence of deep venous thrombosis in high-risk Indian neurosurgical patients: Need for early chemoprophylaxis?

2016 ◽  
Vol 20 (7) ◽  
pp. 412-416 ◽  
Author(s):  
Mathew Joseph ◽  
Shalini Nair ◽  
Ajith John George ◽  
Jayanthi Chinnaiya Karthic
Keyword(s):  
High Risk ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Neurosurgical Patients

scholarly journals Prevention of fatal pulmonary embolism in a patient with stomach cancer

2013 ◽  
Vol 94 (6) ◽  
pp. 903-905
Author(s):  
I A Kamalov ◽  
I R Aglullin ◽  
M G Tukhbatullin ◽  
I R Safin ◽  
A Yu Rodionova
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Inferior Vena Cava ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Set Up

A clinical case of a 71-year old patient with stomach cancer and concomitant lower extremity deep venous thrombosis diagnosed before the surgical treatment is presented. The patient was administered anticoagulants, and despite the treatment, a diagnosis of deep venous thrombosis with high risk for thromboembolism was set up. Considering high risk for pulmonary embolism, an inferior vena cava filter was implanted in infrarenal part of inferior vena cava at the first stage. On the second day after the cancer surgery (subtotal stomach resection with lymphadenectomy), clot detachment and its dislocation from the left common femoral vein to the area where the cava filter was implanted with further fixation were diagnosed. Accurate diagnosis of lower extremity deep venous thrombosis with high risk for thromboembolism set up by ultrasonography and timely inferior vena cava filter implantation saved the patient with cancer from developing pulmonary embolism.

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