Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis

Background Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods The American College of Surgeons’ NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results A total of 2646 patients (65% males and 35% females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29–22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12–38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79–30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27–6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37–7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03–10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54–8.30, p < 0.01), reintubation (OR = 8.93, CI = 2.66–29.97, p < 0.01), and urinary tract infection (OR = 7.64, CI = 2.27–25.73, p < 0.01). Presence of all three factors was associated with a 54% incidence of deep venous thrombosis. Conclusions Development of deep venous thrombosis after lower extremity bypass is a serious but infrequent complication. Patients who require unplanned return to the operating room, reintubation, or develop a postoperative urinary tract are at high risk for developing postoperative deep venous thrombosis. Increased monitoring of these patients and ensuring adequate deep venous thrombosis prophylaxis for such patients is suggested.

Mini TightRope System for Hallux Abducto Valgus Deformity

This case report reviews the presentation and treatment of a 68-year-old diabetic woman with severe hallux abducto valgus deformity and progressively worsening pain and joint stiffness. The patient had a history of two distinct episodes of postoperative deep venous thrombosis and was deemed inappropriate for cast immobilization. The Arthrex Mini TightRope system was used in an attempt to reduce significantly increased intermetatarsal and hallux abductus angles, with the advantage of immediate postoperative weightbearing. An Integra K2 hemi-joint implant was also used to address the marked osteoarthritis at the first metatarsophalangeal joint. The potential role that this fixation technology may play in forefoot surgery is then discussed, along with its limitations and possible complications. (J Am Podiatr Med Assoc 100(4): 291–295, 2010)