Eagleton Matthew J, Grigoryants Vladimir, Peterson David A, Williams David M, Henke Peter K, Wakefield Thomas W, Stanley James C, Upchurch Gilbert R
Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor 48109, USA.
J Vasc Surg. 2002 Nov;36(5):912-6. doi: 10.1067/mva.2002.128640.
This study was performed to define the incidence of acute deep venous thrombosis (DVT) after endovascular treatment of abdominal aortic aneurysms (AAAs). Because aortic endograft placement requires prolonged femoral vessel instrumentation, it may be hypothesized that these patients are at increased risk for development of an acute DVT.
Fifty consecutive patients (42 men, eight women) ranging in age from 48 to 85 years (mean, 72 years) underwent endovascular treatment of an AAA from January 2000 to August 2001. Clinical examination and bilateral lower extremity duplex ultrasonography for DVT were performed on the first postoperative day and at the 1-month follow-up visit. No patient had a prior DVT or identifiable hypercoagulable state. Seven patients (14%) had concurrent malignant disease. Preoperative antiplatelet agents were administered in 26 patients (52%), and nine (18%) were on warfarin sodium therapy before surgery. No new DVT prophylaxis was initiated perioperatively. Epidural anesthesia was used in 60% of the patients, with general endotracheal anesthesia used in the remainder. Risk factors for DVT were evaluated with univariate statistical analysis.
Three patients (6%) had an acute postoperative DVT develop. Two occurred in the femoral veins, and one occurred in the popliteal vein. Of these patients, one had been continued on perioperative anticoagulation therapy, and the remaining two were started on low-molecular weight heparin and warfarin sodium therapy on recognition of the DVT. One patient had an intraoperative injury of the affected common femoral vein, and this individual was the only one to have clinical signs of a DVT. The mean follow-up period was 8 +/- 0.8 months. In this experience, factors that may have placed patients at increased risk for an acute DVT were not identified.
Six percent of patients undergoing endovascular repair of AAAs had postoperative DVT develop. These patients had a number of risk factors for the development of a DVT; however, no specific factor was identified that predisposed to DVT.
本研究旨在确定腹主动脉瘤（AAA）血管内治疗后急性深静脉血栓形成（DVT）的发生率。由于主动脉内移植物置入需要长时间的股血管器械操作，因此可以推测这些患者发生急性DVT的风险增加。
2000年1月至2001年8月，连续50例患者（42例男性，8例女性）接受了AAA血管内治疗，年龄在48至85岁之间（平均72岁）。术后第1天和1个月随访时进行临床检查及双侧下肢DVT的双功超声检查。所有患者既往均无DVT或可识别的高凝状态。7例患者（14%）合并恶性疾病。26例患者（52%）术前使用了抗血小板药物，9例患者（18%）术前接受华法林钠治疗。围手术期未开始新的DVT预防措施。60%的患者使用硬膜外麻醉，其余患者使用全身气管内麻醉。采用单因素统计分析评估DVT的危险因素。
3例患者（6%）术后发生急性DVT。2例发生在股静脉，1例发生在腘静脉。其中，1例患者围手术期持续接受抗凝治疗，其余2例在确诊DVT后开始使用低分子量肝素和华法林钠治疗。1例患者术中患侧股总静脉受伤，该患者是唯一有DVT临床症状的患者。平均随访期为8±0.8个月。在本研究中，未发现可能使患者急性DVT风险增加的因素。
接受AAA血管内修复的患者中有6%术后发生DVT。这些患者有多种发生DVT的危险因素；然而，未发现导致DVT的特定因素。
