Farrell Michael Steven, Knudson M Margaret, Stein Deborah M
Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Trauma Surg Acute Care Open. 2021 Mar 18;6(1):e000687. doi: 10.1136/tsaco-2021-000687. eCollection 2021.
Traumatic lower extremity venous injuries are most commonly managed with either a vein ligation or repair procedure. Venous injuries are associated with an increased risk of developing venous thromboembolisms (VTE), but little is understood with regard to how specific surgical treatments may impact the risk of developing either a deep vein thrombosis (DVT) or a pulmonary embolism (PE). In this study of lower extremity venous injuries, we hypothesized that venous ligation would be associated with an increased risk of DVT but a lower risk of PE when compared with venous repair.
Patients were identified from the National Trauma Data Bank (2008 to 2014) with at least one iliac, femoral, popliteal, or tibial venous injury and who received either a vein ligation or repair. The patients were then compared based on the type of procedure and the location of the injury to assess the risk of DVT and PE between the groups.
A total of 1214 patients were identified. There was no difference between patients who received a vein ligation versus a repair with respect to age, injury severity score, or initial systolic blood pressure. There was no difference in the odds of developing either a DVT or PE between patients who were treated with vein ligation versus repair. There was also no difference in VTE rates when stratified by the location of the injury.
In individuals with lower extremity venous injuries, there is no difference in the rate of DVT or PE complications when comparing venous repair and ligation procedures. The role of anticoagulation remains to be elucidated following operative treatment.
Therapeutic/Care Management, Level IV.
创伤性下肢静脉损伤最常见的治疗方法是静脉结扎或修复手术。静脉损伤与静脉血栓栓塞症（VTE）发生风险增加相关，但对于特定手术治疗如何影响深静脉血栓形成（DVT）或肺栓塞（PE）的风险，人们了解甚少。在这项关于下肢静脉损伤的研究中，我们假设与静脉修复相比，静脉结扎会增加DVT风险，但降低PE风险。
从国家创伤数据库（2008年至2014年）中识别出至少有一处髂静脉、股静脉、腘静脉或胫静脉损伤且接受了静脉结扎或修复的患者。然后根据手术类型和损伤部位对患者进行比较，以评估两组之间DVT和PE的风险。
共识别出1214例患者。接受静脉结扎与修复的患者在年龄、损伤严重程度评分或初始收缩压方面没有差异。接受静脉结扎与修复治疗的患者发生DVT或PE的几率没有差异。按损伤部位分层时，VTE发生率也没有差异。
在下肢静脉损伤患者中，比较静脉修复和结扎手术时，DVT或PE并发症的发生率没有差异。手术治疗后抗凝的作用仍有待阐明。
治疗/护理管理，IV级。
