Symptomatic bilateral massive pulmonary embolism and proximal and distal deep vein thrombosis following arthroscopic...

The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery.

The patient underwent arthroscopic meniscus repair with no intraoperative complication. There were no underlying diseases such as hypertension or diabetes. On day 5 postoperative, the patient complained of dyspnea, chest discomfort, and nausea after standing.

On DVT and PTE computed tomography, there were multifocal PTEs in the distal portion of the main and segmental branches of both pulmonary arteries. There was a focal thrombosis in the left deep femoral vein, as well as small DVTs in the left popliteal and calf veins.

After 3 days of low-molecular-weight heparin 1 mg/kg every 12 hours, treatment was changed to an oral drug, dabigatran, for 6 months.

There were no PTE or DVT findings on computed tomography at 6 months postoperative. The patient did not complain of symptoms related to PTE or DVT at 6 months after the operation, has returned to work, and is living without discomfort.

The frequency of VTE is very low after arthroscopic meniscus surgery, but it represents a life-threatening event. Our patient had risk factors for VTE including obesity, surgery time of ∼60 minutes, and immobilization. Although arthroscopic meniscus surgery is relatively safe, evaluation of risk factors for VTE should be performed before and after surgery, and appropriate thromboprophylaxis should be provided when necessary.