A Study of Venous Pressure in the Lower Leg during Prolonged and Position-Fixed Surgery

Kim, Beom Suk; Kwun, Woo Hyung; Suh, Bo Yang; Kwun, Koing Bo

Abstract

PURPOSE: Deep vein thrombosis and pulmonary embolism are common and potentially fatal complication among hospitalized patients. The first clinical manifestation of venous thromboembolism may be fatal pulmonary embolism. Therefore, some form of prophylaxis is warranted for patients at risk. Prolonged major surgery is well known as high risk factor in development of venous thromboembolism and venous thromboembolism following surgery remains a significant health care problem. But little data are available concerning the changes of venous hemodynamic during prolonged surgery. METHOD: To access the relationship of the lower leg venous congestion that occurred during prolonged and position-fixed surgery to the development of postoperative deep vein thrombosis, the venous pressure of lower leg were measured continuously. A flexible indwelling angiocatheter was inserted into the greater saphenous vein near ankle area and venous pressure was measured by pressure monitor. The data of patients (experimental group:n=10) who performed spinal operation in Jack-Knife position over 180 minutes, healthy volunteers (n=10) and patients (venous hypertension group) who diagnosed as lower leg deep vein thrombosis (n=7), chronic venous insufficiency (n=3) were collected and analyzed. RESULT: The mean age was 34 years old in experimental group and the patients were 7 males and 3 females. The mean lower leg venous pressures of healthy volunteer in Jack-Knife position were 42.89+/-3.52 mmHg at 30 minutes. In acute deep vein thrombosis and chronic venous insufficiency patients, the mean venous pressures were 73.14+/-4.78, 57.33+/-2.52 mmHg at 30 minutes and these data were statistically significant compared with control group (P<0.05). In experimental group, the changes of the mean venous pressures at 30, 60, 90, 120 and 180 minutes were 48.78+/-2.38, 45.89+/-2.09, 45.33+/-2.24, 45.11+/-2.03 and 46.33+/-2.18 mmHg and these data were not statistically significant compared with control group. There was no postoperative development of deep vein thrombosis.
CONCLUSION
The surgical factors (prolonged operation time, fixed position) and anesthetic factor may not play a major role in development of postoperative deep vein thrombosis and other postoperative factors will intervene the development of deep vein thrombosis.