Incidence of Inferior Vena Cava Thrombosis Detected by Transthoracic Echocardiography in the Immediate Postoperative Period after Adult Cardiac and General Surgery

Abstract

Venous thromboembolism is an important complication after general and cardiac surgery. Using transthoracic echocardiography, this study assessed the incidence of inferior vena cava (IVC) thrombosis among a total of 395 and 289 cardiac surgical and major surgical patients in the immediate postoperative period after cardiac and major surgery, respectively. All transthoracic echocardiography was performed by a specialist intensivist within 24 hours after surgery with special emphasis on using the subcostal view in the supine position to visualise the IVC. Of the 395 cardiac surgical patients studied, the IVC was successfully visualised using the subcostal view in 315 patients (79.8%) and eight of these patients (2.5%) had a partially obstructive thrombosis in the IVC. In 250 out of 289 (85%) general surgical patients, the IVC was also clearly visualised, but only one patient (0.4%) had an IVC thrombosis (2.5 vs 0.4%, P <0.05). In summary, visualisation of the IVC was feasible in most patients in the immediate postoperative period after both adult cardiac and major surgery. IVC thrombosis appeared to be more common after adult cardiac surgery than general surgery. A large prospective cohort study is needed to define the risk factors for IVC thrombus and whether early thromboprophylaxis can reduce the incidence of IVC thrombus after adult cardiac surgery.

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

“…We noted that fatal PE after cardiac surgery still occurred within the last decade despite advances in cardiac surgical care, including routine use of low-dose aspirin post-CABG. 23,26,71,73,77 Fatal PE accounted for approximately 11% to 20% of all unexplained deaths after cardiac surgery, with at least 50% not diagnosed before death. 57,58 Median incidence of fatal PE (0.3%) reported in this review was consistent with the data from these 2 postmortem reports if the overall mortality after cardiac surgery was approximately 3%, and this may, in part, explain why omission of early VTE prophylaxis is associated with an increased mortality in the critically ill. 92 Initiating UFH or LMWH, which offers additional VTE protection above intermittent pneumatic lower-limb compression, 93,94 should be seriously considered for all cardiac surgical patients as soon as possible, or on postoperative day 1, if the patients have no active bleeding, especially for those with multiple risk factors for VTE.…”

“…57 Fatal PE was reported within 24 hours of cardiac surgery in at least 1 observational study. 26 The risk factors for VTE after cardiac surgery that remained significant after adjustment by a multivariate analysis are summarized in Table 3. Previous history of VTE, increasing age, obesity, left or right ventricular failure, prolonged bed rest/mechanical ventilation/use of a central venous catheter, and omission of all forms of anticoagulation or -platelet agents were the most consistent risk factors for VTE after cardiac surgery.…”

Successful use of rivaroxaban in inferior vena cava thrombosis provoked by multiple traumatic injuries and surgeries: A case report

“…However, inferior vena cava (IVC) thrombosis is a rare VTE and approximately 3% of patients with lower extremity deep vein thrombosis (DVT) have IVC thrombosis . The incidence of IVC thrombosis within 24 hours after the general surgeries was 0.4%, based on transthoracic echocardiography (TTE) imaging . IVC thrombosis has a large thrombus burden and is associated with twice higher mortality than DVT confined to the lower extremity veins below iliac veins.…”

Perioperative Anesthesiology UltraSonographic Evaluation (PAUSE): A Guided Approach to Perioperative Bedside Ultrasound

“…70 Although numerous case reports exist highlighting management changes with single-view perioperative bedside ultrasound use, adoption of bedside ultrasound remains lacking in anesthesia practice and literature. 34,49,69,[71][72][73][74][75][76][77] There also is no directed approach for the general anesthesiologist regarding a simple and basic guided examination inclusive of lung pathology. Bedside ultrasound should be used perioperatively as an adjunct to the physical examination and should be focused on answering specific clinical questions.…”