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Occult Left Common Iliac Vein Compression Increases Postoperative Venous Thromboembolism Risk Following Total Hip

Michael A Bergen1, Kevin C Wall1, Charles Y Kim2

  • 1Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.

The Journal of Arthroplasty
|November 19, 2018
PubMed

Insights

Occult left common iliac vein compression significantly increases venous thromboembolism risk after hip replacement surgery. This finding may help stratify orthopedic patients for better VTE prevention.

Area of Science:

  • Vascular Surgery
  • Orthopedic Surgery
  • Thrombosis Research

Background:

  • Left common iliac vein (LCIV) compression by iliac arteries can cause venous thromboembolism (VTE).
  • The synergistic effect of occult LCIV compression with orthopedic surgery on VTE risk is not well understood.
  • This study investigates the association between LCIV compression and VTE following total hip or knee arthroplasty (THA, TKA).

Purpose of the Study:

  • To determine if occult left common iliac vein compression increases VTE risk after total hip or knee arthroplasty.
  • To evaluate the predictive value of LCIV compression for postoperative VTE in orthopedic patients.

Main Methods:

  • A case-control study of 112 patients undergoing THA or TKA between 2009 and 2017.
  • Patients with VTE within 30 days of surgery were matched with controls based on various risk factors.
  • LCIV compression was assessed via preoperative imaging (CT/MRI) and defined as 50% diameter reduction.

Main Results:

  • LCIV compression was present in 86.4% of VTE cases versus 51.1% of controls.
  • The overall odds ratio for VTE with LCIV compression was 5.97 (P = .003).
  • In total hip arthroplasty (THA) patients, LCIV compression was highly predictive of VTE (P < .001), but not in total knee arthroplasty (TKA) patients.

Conclusions:

  • Left common iliac vein compression significantly elevates the risk of postoperative VTE following total hip arthroplasty.
  • This association suggests a potential new method for stratifying VTE risk in orthopedic surgery patients.
  • Identifying LCIV compression could aid in reducing VTE-related complications and mortality.
Abstract

Keywords:
May-Thurner syndromedeep vein thrombosisiliac vein compression syndrometotal hip arthroplastytotal knee arthroplastyvenous thromboembolism

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