Incidence of upper extremity deep vein thrombosis in the retrosternal reconstruction after esophagectomy

BMC Surgery

Shotaro Fujita¹  Leo Yamada¹  Misato Ito¹  Akinao Kaneta¹  Shinji Ohki¹  Hiroshi Nakano¹  Motonobu Saito¹  Suguru Hayase¹  Eisei Endo¹  Naoto Yamauchi¹  Yohei Watanabe¹  Zenichiro Saze¹  Tomoyuki Momma¹  Hiroya Suzuki¹  Hirokazu Okayama¹  Koji Kase¹  Yasuyuki Kanke¹  Takuro Matsumoto¹  Koji Kono¹  Shotaro Mochizuki¹  Wataru Sakamoto¹  Hisashi Onozawa¹  Hiroyuki Hanayama¹ 

[1] Department of Gastrointestinal Tract Surgery, Fukushima Medical University;

关键词: Upper extremity deep vein thrombosis;    Esophagectomy;    Retrosternal reconstruction;    Central venous catheter;    Thromboprophylaxis;   

DOI  :  10.1186/s12893-022-01544-9

来源: DOAJ

【 摘 要 】

Abstract Background Upper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there is still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space’s width as a predictive factor for UEDVT in patients receiving esophagectomy. Methods This study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space’s width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space. Results Among all patients, 11 (16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space’s width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P < 0.0001). A cutoff value of the width was 0.21, which has high sensitivity (87%) and specificity (82%) for UEDVT prediction, respectively. Conclusion The existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.

【 授权许可】

Unknown