J Korean Med Sci.  2010 Jan;25(1):28-34. 10.3346/jkms.2010.25.1.28.

Venous Thromboembolism in Korean Patients Undergoing Major Orthopedic Surgery: A Prospective Observational Study using Computed Tomographic (CT) Pulmonary Angiography and Indirect CT Venography

• Cha SI
• Lee SY
• Kim CH
• Park JY
• Jung TH
• Yi JH
• Lee J
• Huh S
• Lee HJ
• Kim SY

• KMID: 1713828
• DOI: http://doi.org/10.3346/jkms.2010.25.1.28

Abstract

In patients undergoing major orthopedic surgery, data of deep venous thrombosis (DVT) and pulmonary embolism (PE) are lacking as studied by computed tomographic (CT) pulmonary angiography and indirect CT venography (CTPA-CTV). A prospective observational study was performed for 363 Korean patients undergoing major orthopedic surgery to determine the incidence of venous thromboembolism (VTE), especially proximal DVT and PE. The incidence of VTE was 16.3% (n=59). Of them, 8 patients (2.2%) were symptomatic. The rate of VTE was the highest in patients who underwent total knee replacement (40.4%), followed by hip fracture surgery (16.4%), and total hip replacement (8.7%; P<0.001). The incidence of PE was 6.6% (n=24). Of them, 4 patients (1.1%) were symptomatic. Forty-one patients (11.3%) were in the proximal DVT or PE group. Based on multivariate analysis, total knee replacement and age > or =65 yr were significant risk factors for proximal DVT or PE in patients undergoing major orthopedic surgery (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1; P=0.025; and OR, 2.1; 95% CI, 1.0-4.4; P=0.046, respectively). Taken together, the overall incidence of PE was 6.6% and rate of symptomatic PE rate was 1.1%. Knee joint replacement and age > or =65 yr were significant risk factors for proximal DVT or PE.

Keyword

Orthopedics; Venous Thromboembolism; Pulmonary Embolism; Computed Tomography

MeSH Terms

Aged
Arthroplasty, Replacement, Knee
Female
Humans
Male
Middle Aged
Odds Ratio
*Orthopedic Procedures
Phlebography
Prospective Studies
Pulmonary Artery/radiography
Pulmonary Embolism/radiography/surgery
Republic of Korea
Risk Factors
Tomography, X-Ray Computed
Venous Thromboembolism/*epidemiology/*radiography
Venous Thrombosis/radiography/surgery

Figure

• 

  Fig. 1 On CT scan, a pulmonary embolus is visualized as a sharply delineated filling defect (arrow) in posterobasal segmental artery of right lower lobe with intact marginal blood flow in at least two consecutive image sections.

• 

  Fig. 2 On CT scan, a deep venous thrombus is demonstrated in right superficial femoral vein as an intraluminal filling defect (arrow) surrounded by a high-attenuating ring of enhanced blood on at least two consecutive transverse images.

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