Early Lower Extremity Fracture Fixation and the Risk of Early Pulmonary Embolus: Filter Before Fixation?

Forsythe, Raquel M.; Peitzman, Andrew B.; DeCato, Thomas W.; Rosengart, Matthew R.; Watson, Gregory A.; Marshall, Gary T.; Ziembicki, Jenny; Billiar, Timothy R.; Sperry, Jason L.

doi:10.1097/ta.0b013e318215b928

Cited by 10 publications

(8 citation statements)

References 27 publications

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“…In addition, venous thromboembolism events remain all too common, having been shown to complicate injury in up to 0.55% of all trauma admissions. 4 Among posttraumatic patients with isolated sudden-onset respiratory symptoms, the clinical scenario alone is not sufficient to distinguish pulmonary FE from thrombotic embolism, and CT should be promptly performed to correctly recognize the underlying disease. 5 At autopsy, presence of fat can be identified in the lung vessels of 47-100% of patients with skeletal trauma.…”

Section: Discussionmentioning

confidence: 99%

Imaging and histological findings of fat embolism in the vena cava

Vasconcelos

Andriotti

Reicher

et al. 2015

Trauma

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We describe an unusual case of a post-traumatic fat embolism in the vena cava and left femoral vein identified on CT before the onset of fat embolism syndrome. The patient was successfully treated by insertion of a vena cava filter and venous thrombectomy. This is the first occurrence of early identification of a large fat embolus allowing its extraction before occurrence of severe respiratory failure.

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Section: Discussionmentioning

confidence: 99%

Imaging and histological findings of fat embolism in the vena cava

Vasconcelos

Andriotti

Reicher

et al. 2015

Trauma

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“…The incidence of acute DVT in patients with lower extremity fractures can be as high as 65%, with a mortality of 4%-7% (1, 13, 14). Although VCFs have significantly decreased the occurrence of fatal PE (2,15,16), permanent filter insertion is associated with longterm complications such as delayed filter migration, filter fracture, and arteriovenous fistula (7,8). Becker et al (7) reported that without anticoagulant treatment, up to 15.3% patients implanted with a filter developed inferior vena cava obstruction, and even with anticoagulation the occlusion rate was 1.7%.…”

Section: Discussionmentioning

confidence: 99%

Tempofilter II implantation in patients with lower extremity fractures and proximal deep vein thrombosis

Jia

Liu²,

Tian³

et al. 2014

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to examine the efficacy and safety of Tempofilter II (B. Braun, Melsungen, Germany) implantation to prevent pulmonary embolism in patients with lower-extremity fractures and proximal deep vein thrombosis (DVT). MATERIALS AND METHODSThe records of patients with lower limb fractures and proximal DVT who were implanted with Tempofilter II devices from May 2004 to August 2009 were reviewed. Data collected included success rate, occurrence of pulmonary embolism, retrieval rate, and complications. RESULTS A total of 176 eligible patients, including 129 males (73.3%) and 47 females (26.7%) with a median age of 42.0 years (interquartile range [IQR], 34.0-52.0 years) were included in the study. Filters were successfully implanted in 174 patients (98.9%). One patient experienced a pulmonary embolism after implantation and died. Filters were removed without complications in all other patients. Median filter implantation time was 27 days (IQR, 25.0-29.0 days). Visible organized thrombi were present on the surface of 144 (82.8%) of filters after removal, and the diameter of most thrombi (n=124) ranged from 0.5 to 1.0 cm. Filters migrated <2 cm in 104 patients (59.8%) and ≥2 cm in five patients (2.9%). In these five cases, three filters migrated into the right atrium and two migrated to the orifice of the renal veins. CONCLUSIONTempofilter II is safe and may be useful in cases of lower extremity fracture with proximal DVT for the prevention of pulmonary embolism. The filter is easily placed and retrieved, and associated with minimal complications.

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“…14,31 We believe this is due to the fact that this analysis focused on a cohort of severely injured patients with evidence of hemorrhagic shock. This population often has a significant multi-system injury burden, including multiple orthopedic injuries.…”

Section: Discussionmentioning

confidence: 99%

Comparing clinical predictors of deep venous thrombosis versus pulmonary embolus after severe injury

Brakenridge

Henley

Kashner

et al. 2013

Journal of Trauma and Acute Care Surgery

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Background The traditional paradigm is that deep venous thrombosis (DVT) and pulmonary embolus (PE) are different temporal phases of a single disease process, most often labeled as the composite endpoint venous thromboembolism (VTE). However, we theorize that after severe blunt injury, DVT and PE may represent independent thrombotic entities rather than different stages of a single pathophysiologic process and therefore exhibit different clinical risk factor profiles. Methods We examined a large, multi-center prospective cohort of severely injured blunt trauma patients to compare clinical risk factors for DVT and PE, including indicators of injury severity, shock, resuscitation parameters, comorbidities and VTE prophylaxis. Independent risk factors for each outcome were determined by cross-validated logistic regression modeling using advanced exhaustive model search procedures. Results The study cohort consisted of 1,822 severely injured blunt trauma patients (median ISS = 33, median base deficit = −9.5). Incidence of DVT and PE were 5.1% and 3.9% respectively. Only 9 of 73 (5.7%) patients with a PE were also diagnosed with DVT. Independent risk factors associated with DVT include prophylaxis initiation within 48 hours (OR 0.57, 95% CI 0.36–0.90) and thoracic AIS ≥ 3 (OR 1.82, 95% CI 1.12–2.95), while independent risk factors for PE were serum lactate >5 (OR 2.33, 95% CI 1.43–3.79) and male gender (OR 2.12, 95% CI 1.17–3.84). Both DVT and PE exhibited differing risk factor profiles from the classic composite endpoint of VTE. Conclusion Deep venous thrombosis and pulmonary embolus exhibit differing risk factor profiles following severe injury. Clinical risk factors for diagnosis of DVT after severe blunt trauma include the inability to initiate prompt pharmacologic prophylaxis and severe thoracic injury, which may represent overall injury burden. In contrast, risk factors for PE are male gender and physiologic evidence of severe shock. We hypothesize that post-injury DVT and PE may represent a broad spectrum of pathologic thrombotic processes as opposed to the current conventional wisdom of peripheral thrombosis and subsequent embolus. Level of Evidence Prognostic study, Level III

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Early Lower Extremity Fracture Fixation and the Risk of Early Pulmonary Embolus: Filter Before Fixation?

Cited by 10 publications

References 27 publications

Imaging and histological findings of fat embolism in the vena cava

Imaging and histological findings of fat embolism in the vena cava

Tempofilter II implantation in patients with lower extremity fractures and proximal deep vein thrombosis

Comparing clinical predictors of deep venous thrombosis versus pulmonary embolus after severe injury

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