Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon.
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Medicine (Baltimore). 2021 Apr 2;100(13):e25372. doi: 10.1097/MD.0000000000025372.
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.
膝关节镜检查后静脉血栓栓塞症（VTE）的发生率明显低于关节置换术。我们描述了一位患者在接受半月板关节镜修复手术后出现双侧症状性巨大肺血栓栓塞症（PTE）和股静脉及腘静脉深静脉血栓形成（DVT）。
患者接受了半月板关节镜修复术，术中无并发症。无高血压或糖尿病等潜在疾病。术后第 5 天，患者站立后出现呼吸困难、胸部不适和恶心。
在 DVT 和 PTE 计算机断层扫描中，双侧肺动脉的主支和段支的远端有多发 PTE。左股深静脉有局灶性血栓形成，左腘静脉和小腿静脉有小的 DVT。
在皮下注射低分子肝素 1mg/kg 每 12 小时 3 天后，改为口服药物达比加群，治疗 6 个月。
术后 6 个月计算机断层扫描未见 PTE 或 DVT 发现。术后 6 个月，患者无 PTE 或 DVT 相关症状，已恢复工作，生活无不适。
半月板关节镜手术后 VTE 的发生率非常低，但它是一种危及生命的事件。我们的患者有 VTE 的危险因素，包括肥胖、手术时间约 60 分钟和固定。虽然半月板关节镜手术相对安全，但应在术前和术后评估 VTE 的危险因素，并在必要时提供适当的血栓预防措施。
