Symptomatic bilateral pulmonary embolism without deep venous thrombosis in an adolescent following arthroscopic anterior cruciate ligament reconstruction: a case report and review of the literature

Bourget-Murray, Jonathan; Clarke, Mathew; Gorzitza, Sydney; Phillips, Lisa

doi:10.1186/s13256-018-1726-8

Cited by 6 publications

(6 citation statements)

References 6 publications

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“…However, asymptomatic DVT has been reported to be associated with increased risk of short-term all-cause mortality in patients hospitalized with an acute medical illness, 10 and with postthrombotic syndrome. 23 Moreover, there have been reports of cases with fatal VTE after ACLR, 2 , 11 , 17 suggesting that the focus should be placed on the prevention of DVT.…”

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confidence: 99%

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Nagashima

Takeshima

Origuchi

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Deep venous thrombosis (DVT) and pulmonary embolism are serious potential complications after anterior cruciate ligament reconstruction (ACLR). Little is known about the influence of tourniquet use on the incidence of DVT after ACLR. Purpose: To compare the incidence of DVT after ACLR with and without the use of a tourniquet. Study Design: Cohort study; Level of evidence, 3. Methods: Between November 2018 and May 2020, a total of 60 consecutive ACLRs in 60 patients, including 7 revision surgeries, were performed without tourniquet use at our hospital and were enrolled in this study (T– group). In addition, 55 consecutive ACLRs in 55 patients, including 10 revision surgeries, were performed with tourniquet use between April 2017 and September 2018 and were enrolled as the control group (T+ group). DVT was diagnosed using ultrasonography of both legs performed preoperatively and at postoperative week 1. The incidence of postoperative DVT was compared between the T– and T+ groups. Logistic regression analysis was performed to evaluate the effect of older age (≥40 vs <40 years) and tourniquet use on the occurrence of DVT. Results: No DVTs were detected preoperatively. The incidence of postoperative DVT was significantly lower in the T– group compared with the T+ group (1 patient [1.7%] vs 9 patients [16.4%]; P = .005). All patients with DVT were asymptomatic. Although the mean operative time was not significantly different (80.8 minutes in the T+ group vs 78.5 minutes in the T– group; P = .461), the mean blood loss from the drain was significantly lower in the T– group than in the T+ group (149.9 vs 201.9 mL; P < .001). Age ≥40 years and tourniquet use were significantly related to the occurrence of DVT (odds ratio, 8.3 [95% CI, 1.9-36.8]; P = .005; and odds ratio, 8.8 [95% CI, 1.0-75.3]; P = .047, respectively). Conclusion: ACLRs performed without tourniquet resulted in a significantly lower incidence of DVT after ACLR and significantly less bleeding from drains. If adequate visibility of the surgical field is obtained, ACLR without tourniquet use may reduce the incidence of DVT.

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confidence: 99%

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Nagashima

Takeshima

Origuchi

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Second, since CECT was performed only for patients found to have DVT after ACLR, not all patients underwent CECT. Since cases of symptomatic PE without DVT following ACLR have been reported,11 12 the incidence of PE in this study might still have been underestimated.…”

Section: Discussionmentioning

confidence: 76%

“…In the present study, the incidence of asymptomatic PE was unexpectedly high. There are reports of cases with fatal PE after ACLR 11 12. Thus, the prevention of DVT and PE after ACLR should be considered an urgent issue.…”

Section: Discussionmentioning

confidence: 99%

Unexpectedly high incidence of venous thromboembolism after arthroscopic anterior cruciate ligament reconstruction: prospective, observational study

et al. 2020

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“…Indeed, the risk of thrombosis is low, so there is no need for thrombosis prevention in the perioperative period [7][8][9][10]. Recently, some cases of symptomatic DVT and PTE after partial meniscus resection, anterior cruciate ligament reconstruction, multiple ligament reconstruction and repair with arthroscopy have been reported [10][11][12]. However, no early symptomatic PE with successful therapy after knee arthroscopy has been reported to date.…”

Section: Discussionmentioning

confidence: 99%

Bilateral pulmonary embolism without deep venous thrombosis was observed after knee arthroscopy: a case report

Chen

Deng

et al. 2021

BMC Musculoskelet Disord

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Background Symptomatic pulmonary embolism (PE) after knee arthroscopy is extremely rare. If the embolism is not treated promptly, the patient may die. Bilateral pulmonary embolism with associated pulmonary infarct without concomitant deep vein thrombosis has never been reported following routine knee arthroscopy. Case presentation A 50-year-old female patient with no other risk factors other than hypertension, obesity, varicose veins in the ipsilateral lower extremities and elevated triglyceride (TG) presented to our ward. She had experienced sudden chest tightness, polypnea and fainting after going to the bathroom the morning of the second postoperative day and received emergency medical attention. Colour ultrasonography of the extremities showed no deep vein thrombosis. Lung computed tomography angiography (CTA) showed multiple embolisms scattered in both pulmonary artery branches. Thus, emergency interventional thrombolysis therapy was performed, followed by postoperative symptomatic treatment with drugs with thrombolytic, anticoagulant and protective activities. One week later, lung CTA showed a significant improvement in the PEs compared with those in the previous examination. Since the aetiology of PE and no obvious symptoms were discerned, the patient was discharged. Conclusion Although knee arthroscopy is a minimally invasive and quick procedure, the risk factors for PE in the perioperative period should be considered and fully evaluated to enhance PE detection. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. Finally, clear guidelines regarding VTE thromboprophylaxis following knee arthroscopy in patients with a low risk of VTE development are needed.

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Symptomatic bilateral pulmonary embolism without deep venous thrombosis in an adolescent following arthroscopic anterior cruciate ligament reconstruction: a case report and review of the literature

Cited by 6 publications

References 6 publications

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Unexpectedly high incidence of venous thromboembolism after arthroscopic anterior cruciate ligament reconstruction: prospective, observational study

Bilateral pulmonary embolism without deep venous thrombosis was observed after knee arthroscopy: a case report

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