The pathophysiology of venous thromboembolism: implications with compression garments.
The highest risk of venous thromboembolism lies with abdominoplasty and liposuction and deaths increase when combined with other procedures. The objective of this study was to evaluate physiologic changes in the deep venous system with compression-garments and asses whether there is a correlation between these procedures, rectus plication, and garments. Part 1 of this article is a retrospective review of all office surgical incidents that resulted in an abdominoplasty and/or liposuction death in the state of Florida over the past 8 years. Part 2 is a clinical study, evaluating the effect compression garments have on the pathophysiology of venous thromboembolism. Duplex ultrasounds were performed with and without garments to evaluate venous changes. Literature was reviewed related to intraabdominal pressure and high-tension abdominal closures and surgeons were polled about their use of rectus plication and garments/binders. In 8 years, 13 patients died related to abdominoplasty, liposuction, or the combination of the 2. In 100% of subjects, ultrasounds showed a decrease in venous flow, proximal vessel dilation, and loss of normal biphasic flow within the popliteal vein. Multiple publications have reported an increased morbidity and mortality related to liposuction and abdominoplasty procedures. The most frequent cause of death with these types of procedures was thromboembolism, and we discuss possible reasons for this increased rate. The exact cause of deep venous thrombosis in these procedures remains unknown, but postoperative garments may affect the physiology of venous flow, and may be involved in the formation of deep venous thrombosis and should be considered along with other patient safety procedures.
Clayman
Mark A
MA
Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL, USA. mclayman@ufl.edu
Clayman
Eric S
ES
Seagle
Brent M
BM
Sadove
Richard
R
D000328:Adult; D015984:Causality; D002423:Cause of Death; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D015187:Lipectomy / Q000009:adverse effects / Q000401:mortality; D011152:Popliteal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D011182:Postoperative Care / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000401:mortality*; D012016:Reference Values; D012039:Regional Blood Flow; D012189:Retrospective Studies; D053828:Stockings, Compression / Q000009:adverse effects* / Q000706:statistics & numerical data; D014463:Ultrasonography; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology