diagnosis of asymptomatic DVTs allows for intervention and prevention of PEs. 33 , 34 , 37 , 38 , 42 , 45 Guidelines from the American College of Chest Physicians recommend against the routine use of LEDUS to screen for DVTs, but they do recommend treatment with either anticoagulant medication or inferior vena cava (IVC) filter placement in patients diagnosed with an asymptomatic proximal DVT. 23 Such studies in combination with current guidelines have led many neurosurgery departments at many institutions, including the University of Mississippi Medical Center (UMMC
James C. Dickerson, Katherine L. Harriel, Robert J. Dambrino IV, Lorne I. Taylor, Jordan A. Rimes, Ryan W. Chapman, Andrew S. Desrosiers, Jason E. Tullis and Chad W. Washington
Anmol Pandey, Bhaskar Thakur, Florence Hogg, Christian Brogna, Jamie Logan, Roopen Arya, Richard Gullan, Ranjeev Bhangoo and Keyoumars Ashkan
toward the frontline use of direct oral anticoagulant agents. 16 If neurosurgical intervention is to be undertaken in a patient with a known DVT or PE, a risk-benefit judgment must be made regarding the risk of complications from VTE versus intracranial hemorrhage. If preoperative pharmacological treatment is indicated, it must be tightly regulated and sufficiently short acting to allow planning for timing of surgery. Inferior vena cava (IVC) filters have been shown to reduce the risk of PE in patients with DVT who have contraindications to anticoagulation therapy. 6
Alik S. Widge, Nestor D. Tomycz and Adam S. Kanter
anesthesia or bowel/bladder incontinence. Case Report History and Presentation This 55-year-old Caucasian male presented with a rapidly progressive paraparesis 16 days after admission to the hospital following an assault. His medical history included a warfarindependent factor V Leiden mutation, DVT, pulmonary embolus, IVC filter placement, and lumbar stenosis. The patient was neurologically intact upon admission. He subsequently developed a lower-extremity compartment syndrome necessitating multiple left lower-extremity fasciotomies. His anticoagulation
Michael K. Rosner, Timothy R. Kuklo, Rabih Tawk, Ross Moquin and Stephen L. Ondra
The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction.
In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria.
In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted.
In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.
Cecilia L. Dalle Ore, Christopher P. Ames, Vedat Deviren and Darryl Lau
/PE, 50% were anticoagulated and an inferior vena cava (IVC) filter was placed in 50%. No patients were hemodynamically unstable as a result of their PE. TABLE 3. Rate of perioperative complications in patients with and without RA RA Non-RA p Value Complications 7 (38.9%) 63 (29.0%) 0.380 Medical complications 7 (38.9%) 46 (21.2%) 0.084 Cardiac complications 3 (16.7%) 26 (12.0%) 0.561 DVT/PE 2 (11.1%) 4 (1.8%) 0.017 AKI 1 (5.6%) 11 (5.1%) 0.928 UTI 1 (5.6%) 8 (3.7%) 0.691 Pulmonary complications 1 (5.6%) 4 (1.8%) 0.294 GI complications 0 (0%) 7 (3.2%) 0
E. Antonio Chiocca and Judith A. Schwartzbaum
suggests that older patients who died may have been more likely to have been diagnosed with VTE had they lived. This potential “informative censoring” has no immediate clinical implications; however, as new treatments are developed and survival increases among patients at least 75 years of age, it is possible that their risk of VTE may also increase. A second point, noted by the authors, is that the inferior vena cava (IVC) filter was not randomly assigned. Therefore, before treatment, patients treated with the IVC filter may have been at greater risk of recurrent VTE
Thomas J. Semrad, Robert O'Donnell, Ted Wun, Helen Chew, Danielle Harvey, Hong Zhou and Richard H. White
incidence of VTEs in patients with brain cancer may be comparable with that in patients suffering from pancreatic cancer. 21 , 28 The principal objectives of the present study were to determine the incidence, time course, and risk factors associated with the development of a VTE in a population-based cohort of patients with malignant glioma. We also sought to determine if the development of VTEs was associated with an increased risk of death and if the placement of an IVC filter was associated with a reduced risk of VTE recurrence. Clinical Material and Methods
Ekamjeet S. Dhillon, Ryan Khanna, Michael Cloney, Helena Roberts, George R. Cybulski, Tyler R. Koski, Zachary A. Smith and Nader S. Dahdaleh
by the of International Classification of Diseases , Ninth Revision (ICD-9) codes. Procedure Data We collected the following data about the procedures performed: whether an inferior vena cava (IVC) filter was placed prophylactically, the site of surgery (cervical, thoracic, lumbar, or other), whether a fusion was part of the procedure, whether decompression (laminectomy or laminotomy) was a part of the procedure, whether the surgery was staged across multiple days, the length of surgery (minutes), the length of anesthesia (minutes), estimated blood loss (EBL
Brad E. Zacharia, Sweena Kahn, Evan D. Bander, Gustav Y. Cederquist, William P. Cope, Lily McLaughlin, Alexa Hijazi, Anne S. Reiner, Ilya Laufer and Mark Bilsky
Protocol Preoperative ultrasonographic screening for DVT was routinely performed during the study period. Patients in which this screening was positive typically underwent preoperative placement of an inferior vena cava (IVC) filter, which was performed with the intention of mitigating postoperative PE risk. In addition to IVC filter placement a concerted effort was made to initiate mechanical (in patients without DVT) and/or pharmacological prophylaxis on postoperative Day 1 in all patients. Routine postoperative VTE screening was not performed in this population. We
Hisashi Yoshimoto, Shigenobu Sato, Izumi Nakagawa, Takahiko Hyakumachi, Yasushi Yanagibashi, Fumihito Nitta and Takeshi Masuda
left CIV at the bifurcation can be seen (arrows) . Second Operation and Postoperative Course Using ultrasonography guidance, we observed a thrombus at the site of venous compression. Because there were concerns about the possibility of a PE if the thrombus migrated during surgical manipulation of the affected left CIV, a cardiologist installed a removable IVC filter preoperatively. Excision of the bone fragment was successfully performed. The left CIV was obviously entrapped between the migrated bone graft fragment and the left common iliac artery. The