Retrosternal Reconstruction Can be a Risk Factor for Upper Extremity Deep Vein Thrombosis After Esophagectomy

Takahashi, Toshifumi; Fukaya, Masahide; Miyata, Kazushi; Sakatoku, Yayoi; Nagino, Masato

doi:10.1007/s00268-017-4120-6

Cited by 6 publications

(7 citation statements)

References 46 publications

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“…Among several factors in the reconstructive route, the width of retrosternal space has been mentioned as an important factor affecting compression strength. The previous report mentioned there is a significant difference in the width of retrosternal space, and the ratio of thinner space tends to be higher to generate thrombosis (11). Following the definition of the retrosternal space ratio, our cutoff value (0.21) shows high sensitivity of 87% and specificity of 82%, which is similar to the previous report.…”

Section: Discussionsupporting

confidence: 86%

“…Our present study revealed no significant difference to cause UEDVT whether CVC exists or not. The frequency of UEDVT without CVC cases was 18.6% and is comparable to the previous report (11). Since this case series consisted of a minor population of patients receiving CVC insertion, it is difficult to draw a solid conclusion regarding if the CVC insertion could increase the incidence of UEDVT in esophagectomy patients.…”

Section: Discussionsupporting

confidence: 79%

“…VTE is an emerging complication requiring continuous attention as well as other surgical complications, especially in highly invasive surgery like esophagectomy. In VTE, LEDVT tends to attract attention in general, but the frequency of UEDVT is not negligible due to the characteristic of esophagectomy, which conducts cervical manipulation and reconstructs through a narrow retrosternal pathway (11). According to the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File (ACS-NSQIP PUF), the incidence of DVT is about 7%, and UEDVT comprises 57% of all DVTs in the analysis of more than 460000 cases of general surgery, except esophagectomy (15).…”

Section: Discussionmentioning

confidence: 99%

“…Several reports mentioned the disadvantages of the retrosternal route, such as cardiac compression and reconstructed organs' necrosis, when the retrosternal space is narrow (19) (20). Retrosternal reconstruction has been reported as an independent risk factor for UEDVT after esophagectomy, and its ratio of UEDVT is 25.5%, significantly higher than 4.9% of posterior mediastinal reconstruction (11). Retrosternally shifted gastric tube may contribute to the left brachiocephalic vein's compression and form UEDVT in the proximal left-side veins (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…In esophageal cancer patients who underwent esophagectomy followed by gastric tube reconstruction, Takahashi et al reported that the compression of the left brachiocephalic vein by the narrowness of retrosternal space contributes to the occurrence of UEDVT and referred to the significant difference in the likelihood to generate UEDVT by retrosternal reconstruction compared with the posterior mediastinal route. Also, the effectiveness of preoperative CT examination for evaluating the width of retrosternal was revealed as a predictive factor for UEDVT (11). However, in the previous study, all the participants received CVC before esophagectomy, and it has not been described whether CVC placement increases the UEDVT occurrence.…”

Section: Introductionmentioning

confidence: 88%

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Clinical Impact of Upper Extremity Deep Vein Thrombosis in the Retrosternal Reconstruction After Esophagectomy

Yamada

Saito

Suzuki

et al. 2021

Preprint

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Background Upper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there are still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space’s width as a predictive factor for UEDVT in patients receiving esophagectomy. Methods This study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space’s width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space. Results Among all patients, 11(16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space’s width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P < 0.0001). A cutoff value of the width was 0.21, which has high sensitivity (87%) and specificity (82%) for UEDVT prediction, respectively. Conclusion The existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 79%