Skip to main content
SpringerLink
Log in

Perioperative Venous Thromboembolism

  • Chapter
  • First Online:
Vascular Complications of Surgery and Intervention

Abstract

Venous thromboembolism (VTE) persists in hospitalized patients in spite of well-recognized risk factors. VTE includes deep vein thrombosis (DVT) as well as pulmonary embolism (PE). Virchow’s triad explains the pathophysiology underlying VTE, and is comprised of venous stasis, endothelial injury, and hypercoagulability. In the lower extremity, because signs and symptoms (swelling, pain, and discoloration) remain subtle or occult in up to 50% of patients, a high index of clinician suspicion is required to minimize undiagnosed cases. The Caprini score is an excellent tool to assist in VTE risk stratification and can help guide prophylaxis with low molecular weight heparin and sequential compression devices. Duplex ultrasound is the initial diagnostic test of choice. In the upper extremity, DVT is often iatrogenic and secondary to indwelling devices, such as central venous catheters or pacemaker leads. Pulmonary embolism occurs in up to 40% of DVT. Untreated, the mortality of PE is at least 25%. Long-term sequelae of VTE include postphlebitic syndrome and pulmonary hypertension. Initial treatment of VTE consists of systemic anticoagulation. Percutaneous interventions are reserved for severe cases of iliofemoral DVT or massive PE.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Dobromirski M, Cohen AT. How I manage venous thromboembolism risk in hospitalized medical patients. Blood. 2012;120(8):1562–9. https://doi.org/10.1182/blood-2012-03-378901.

    Article  CAS  PubMed  Google Scholar 

  2. Cohen AT, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE Study): a multinational cross-sectional study. Lancet. 2008;371(9610):387–94. https://doi.org/10.1016/s0140-6736(08)60202-0.

    Article  PubMed  Google Scholar 

  3. Muñoz FJ, et al. Clinical outcome of patients with upper-extremity deep vein thrombosis. Chest. 2008;133(1):143–8. https://doi.org/10.1378/chest.07-1432.

    Article  PubMed  Google Scholar 

  4. Douketis JD, et al. Deep venous thrombosis (DVT) – cardiovascular disorders. Merck Manuals Professional Edition. Merck Manuals; 2021.

    Google Scholar 

  5. Kahn SR. The post-thrombotic syndrome. Hematology. 2016;2016(1):413–8. https://doi.org/10.1182/asheducation-2016.1.413.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Prandoni P, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. J Vasc Surg. 2005;41(1):177. https://doi.org/10.1016/j.jvs.2004.10.021.

    Article  Google Scholar 

  7. Amaragiri, Sachiendra V, and Timothy Lees. “Elastic compression stockings for prevention of deep vein thrombosis.” Cochrane Database Syst Rev, 2000 (3):CD001484, doi:https://doi.org/10.1002/14651858.cd001484.

    Book  Google Scholar 

  8. Roderick P, et al. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol Assess. 2005;9(49):iii–iv, ix–x, 1–78. https://doi.org/10.3310/hta9490.

    Article  PubMed  Google Scholar 

  9. Vanek VW. Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh-high to knee-high sleeves. Am Surg. 1998;64(11):1050–8. https://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?AccessionNumber=11998001884&AccessionNumber=11998001884. Accessed 6 Oct 2019.

    CAS  PubMed  Google Scholar 

  10. Laporte-Simitsidis S, et al. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials. Thromb Haemost. 2000;83(01):14–9. https://doi.org/10.1055/s-0037-1613749.

    Article  PubMed  Google Scholar 

  11. Watson L, et al. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2016;11(11):CD002783. https://doi.org/10.1002/14651858.cd002783.pub4.

    Article  PubMed  Google Scholar 

  12. Vedantham S, et al. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014;25(9):1317–25. https://doi.org/10.1016/j.jvir.2014.04.019.

    Article  PubMed  Google Scholar 

  13. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I4–8. https://doi.org/10.1161/01.cir.0000078468.11849.66.

    Article  PubMed  Google Scholar 

  14. Moheimani F, Jackson DE. Venous thromboembolism: classification, risk factors, diagnosis, and management. ISRN Hematol. 2011;2011:1–7. https://doi.org/10.5402/2011/124610.

    Article  CAS  Google Scholar 

  15. Anderson FA, Wheeler HB. Physician practices in the management of venous thromboembolism: a community-wide survey. J Vasc Surg. 1992;16(5):707–14. https://doi.org/10.1016/0741-5214(92)90225-w.

    Article  PubMed  Google Scholar 

  16. Anderson FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9–16. https://doi.org/10.1161/01.cir.0000078469.07362.e6.

    Article  PubMed  Google Scholar 

  17. Ho WK, et al. Risk of recurrent venous thromboembolism in patients with common thrombophilia. Arch Intern Med. 2006;166(7):729. https://doi.org/10.1001/archinte.166.7.729.

    Article  CAS  PubMed  Google Scholar 

  18. Tapson VF. The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2(1):71–7. https://doi.org/10.1513/pats.200407-038ms.

    Article  CAS  PubMed  Google Scholar 

  19. Feher MD, et al. Acute changes in atherogenic and thrombogenic factors with cessation of smoking. J R Soc Med. 1990;83(3):146–8. https://doi.org/10.1177/014107689008300306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Comerota AJ, et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation. 2019;139(9):1162–73. https://doi.org/10.1161/circulationaha.118.037425.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Doleman B, et al. Phlegmasia caerulea dolens secondary to pelvic plasmacytoma and left femoral deep vein thrombosis. Int J Surg Case Rep. 2013;4(10):825–7. https://doi.org/10.1016/j.ijscr.2013.07.010.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kahn SR, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. J Vasc Surg. 2009;49(5):1358. https://doi.org/10.1016/j.jvs.2009.03.021.

    Article  Google Scholar 

  23. Farrell JJ, et al. Incidence and interventions for post-thrombotic syndrome. Cardiovasc Diagn Ther. 2016;6(6):623–31. https://doi.org/10.21037/cdt.2016.11.22.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22–30. https://doi.org/10.1161/01.cir.0000078464.82671.78.

    Article  PubMed  Google Scholar 

  25. Min S-K, et al. Diagnosis and treatment of lower extremity deep vein thrombosis: Korean practice guidelines. Vasc Specialist Int. 2016;32(3):77–104. https://doi.org/10.5758/vsi.2016.32.3.77.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Casey ET, et al. Treatment of acute iliofemoral deep vein thrombosis. J Vasc Surg. 2012;55(5):1463–73. https://doi.org/10.1016/j.jvs.2011.12.082.

    Article  PubMed  Google Scholar 

  27. Bĕlohlávek J, et al. Pulmonary embolism, part I: epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013;18(2):129–38.

    PubMed  PubMed Central  Google Scholar 

  28. Horlander KT, et al. Pulmonary embolism mortality in the United States, 1979–1998. Arch Intern Med. 2003;163(14):1711. https://doi.org/10.1001/archinte.163.14.1711.

    Article  PubMed  Google Scholar 

  29. Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic syndrome. Arch Intern Med. 2004;164(1):17. https://doi.org/10.1001/archinte.164.1.17.

    Article  PubMed  Google Scholar 

  30. Mumoli N, et al. Phlegmasia cerulea dolens. Circulation. 2012;125(8):1056–7. https://doi.org/10.1161/circulationaha.111.051912.

    Article  PubMed  Google Scholar 

  31. Kropp AT, et al. The efficacy of forceful ankle and toe exercises to increase venous return: a comprehensive doppler ultrasound study. Phlebology. 2017;33(5):330–7. https://doi.org/10.1177/0268355517706042.

    Article  PubMed  Google Scholar 

  32. Bose E, Hravnak M. Thromboelastography: a practice summary for nurse practitioners treating hemorrhage. J Nurse Pract. 2015;11(7):702–9. https://doi.org/10.1016/j.nurpra.2015.05.006.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Chaochankit W, Akaraborworn O. Phlegmasia cerulea dolens with compartment syndrome. Ann Vasc Dis. 2018;11(3):355–7. https://doi.org/10.3400/avd.cr.18-00030.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Goodacre S, et al. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging. 2005;5(1):6. https://doi.org/10.1186/1471-2342-5-6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nicolas D, Nicolas S, Reed M. Heparin induced thrombocytopenia (HIT) [updated 2020 Feb 14]. In: StatPearls [internet]. Treasure Island (FL): StatPearls Publishing; 2020.

    Google Scholar 

  36. Morrison H. Catheter-directed thrombolysis for acute limb ischemia. Semin Interv Radiol. 2006;23(3):258–69. https://doi.org/10.1055/s-2006-948765.

    Article  Google Scholar 

  37. Kearon C, et al. Antithrombotic therapy for VTE disease. Chest. 2012;141(2):E419S–96S. https://doi.org/10.1378/chest.11-2301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Chung J, et al. Pilot study evaluating the efficacy of exergaming for the prevention of deep venous thrombosis. J Vasc Surg. 2017;66(3):e55–6. https://doi.org/10.1016/j.jvs.2017.05.071.

    Article  Google Scholar 

  39. Van Der Heijden JF, et al. Vitamin K antagonists or low-molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism. Cochrane Database Syst Rev. 2001;4:CD002001. https://doi.org/10.1002/14651858.cd002001.

    Article  Google Scholar 

  40. Neglén P, et al. Endovascular surgery in the treatment of chronic primary and post-thrombotic iliac vein obstruction. Eur J Vasc Endovasc Surg. 2000;20(6):560–71. https://doi.org/10.1053/ejvs.2000.1251.

    Article  PubMed  Google Scholar 

  41. Srinivas BC, et al. Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis: a prospective study with venous doppler follow-up at 1-year. Cardiovasc Interv Ther. 2015;30(4):320–6. https://doi.org/10.1007/s12928-015-0317-5.

    Article  CAS  PubMed  Google Scholar 

  42. Vedantham S, et al. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):68–80. https://doi.org/10.1007/s11239-015-1318-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Nawar Hudefi & Jayer Chung

Authors
  1. Nawar Hudefi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jayer Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jayer Chung .

Editor information

Editors and Affiliations

  1. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Ramyar Gilani

  2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Joseph L. Mills Sr.

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hudefi, N., Chung, J. (2022). Perioperative Venous Thromboembolism. In: Gilani, R., Mills Sr., J.L. (eds) Vascular Complications of Surgery and Intervention. Springer, Cham. https://doi.org/10.1007/978-3-030-86713-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-86713-3_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-86712-6

  • Online ISBN: 978-3-030-86713-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation