Iliofemoral venous injuries: an indication for prophylactic caval filter placement
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L P Sue1, J W Davis, S N Parks
1Department of Surgery, University of California, San Francisco/ Fresno, Valley Medical Center 93702, USA.
Insights
Trauma patients with iliofemoral venous injuries face high risks of deep venous thrombosis (DVT) and pulmonary embolism (PE). Prophylactic vena cava filters are recommended for these high-risk patients to prevent DVT/PE complications.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Cardiovascular Medicine
Background:
- Prophylactic placement of vena caval filters is standard for trauma patients at high risk for pulmonary embolism (PE).
- Iliofemoral venous trauma presents a specific challenge for deep venous thrombosis (DVT) and PE prevention.
Observation:
- This study reviewed twelve patients with iliac or common femoral venous injuries.
- Seven patients underwent primary venous repair and received standard DVT/PE prophylaxis.
- Despite prophylaxis, three patients developed DVT/PE, and one had suspected PE.
Findings:
- The complication rate for DVT/PE in patients with repaired iliofemoral venous injuries was at least 43% (3 of 7).
- Three patients received prophylactic vena cava filters without complications.
- Repaired iliofemoral venous injuries constitute a high-risk subgroup for DVT/PE.
Implications:
- Prophylactic vena cava filter placement should be strongly considered in patients with repaired iliofemoral venous injuries.
- Enhanced surveillance and prophylaxis strategies may be necessary for this patient population.
- Further research is warranted to optimize DVT/PE prevention in trauma patients with complex venous injuries.
Abstract:
Prophylactic placement of vena caval filters is recommended in trauma patients at high risk for pulmonary embolism (PE). We present a group of patients with iliofemoral venous trauma, and subsequent complications of deep venous thrombosis (DVT) and PE. Of twelve patients with iliac or common femoral venous injuries, seven underwent primary repair. All received DVT/ PE prophylaxis with mini-dose heparin and/or sequential compression hose. In spite of this, two patients suffered DVT, one patient had DVT and PE and one patient had clinical evidence of PE but did not undergo confirmatory testing. Three patients underwent prophylactic caval filter placement without complication. The DVT/PE complication rate in this small group was at least 43% (3 of 7). Patients with repaired iliofemoral venous injuries represent a high risk subset for DVT/PE and prophylactic caval filter placement is recommended.