Laterality of lower extremity deep vein thrombosis after colectomy: A retrospective study using the national inpatient sample

Abstract

Background and aims Deep venous thrombosis (DVT) is known to occur preferentially on the left lower extremity. The renowned surgeon Denis Burkitt advanced the theory that a heavy sigmoid colon would compress the left pelvic veins and predispose to DVT. Our study aimed to evaluate this hypothesis by comparing the laterality distributions with and without a prior colectomy. Methods We conducted a retrospective analysis of the 2016 National Inpatient Sample database by stratifying the patients at any age with acute DVT of lower extremity by history of prior colectomy, thereby eliminating local gut mechanical factors in the development of DVT. We compared the laterality distribution (i.e., left, right, bilateral, and unspecified) between the patients with and without a prior colectomy. We also conducted a subgroup analysis by the sex category to examine the difference in laterality distribution for male and female patients. Chi-square test for independence was used. P value ≤0.05 was considered statistically significant. Results We found an estimated total of 342,525 cases. Among patients without a prior colectomy, 136,605 (41.6%) were left-sided DVT versus 119,555 (36.4%) right-sided, with 55,555 bilateral and 16,865 unspecified. Among patients with a prior colectomy, 5,750 (41.2%) were left-sided, 5,000 (35.9%) were right-sided, 2,345 were bilateral and 850 were unspecified. The laterality distribution between the two groups was not significantly different ( p = .167). The left-side predominance disappeared only in males with a prior colectomy (37.1% for left vs. 38.9% for right, p = .027). Conclusions Our findings did not confirm the Burkitt’s hypothesis. The left-side predominance of lower extremity DVT was attenuated only in male patients with a prior colectomy.

Lower limb deep vein thrombosis left to right ratio and novel anatomical classification / Razão esquerda-direita de tromboses venosas profundas de membros inferiores e nova classificação anatômica

“…Findings that support a higher than 1.0 L:R ratio for all patients and a lower L:R in men when compared to women in greater populations, have already been reported. 4,5 This increased prevalence of thrombotic events in the left lower limb is widely explored and is explained by the compression of the right iliac artery over the left iliac vein, however, the great disparity between women and men demands a larger population sample. The differential diagnosis of iliac compression syndrome should always be considered for patients with left DVT, thus, in these cases, the left iliac vein should be assessed by the radiologist or DU technician, given its epidemiological relevance.…”