title: Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery.
abstract: Deep vein thrombosis (DVT) develops after major orthopedic surgery despite the current use of prophylaxis. DVT frequently develops in the soleal vein (SV) and might develop easily at the site of SV dilatation because of blood flow stasis. However, whether preoperative SV dilatation detected by ultrasonography predicts DVT after major orthopedic surgery remains unknown.
  
  
  
  We examined whether SV dilatation detected by preoperative ultrasonography predicts DVT after major orthopedic surgery.
  
  
  
  Ultrasonography was performed preoperatively and postoperatively in 243 patients with orthopedic diseases (mean age of 67±13 years, 77% women) who underwent total hip arthroplasty (THA, n=180) or total knee arthroplasty (TKA, n=63). Presence of DVT was diagnosed by ultrasonography and SV diameter ≥10mm was defined as SV dilatation. Patients with preoperative DVT were excluded.
  
  
  
  Sixty-nine patients (28%) developed postoperative DVT. SV dilatation was found in 24 patients (10%), and 16 (67%) of those patients had postoperative DVT. Multivariate logistic regression analysis showed that female gender [odds ratio (OR): 4.09, p=0.004], TKA (OR: 2.52, p=0.011), and SV dilatation (OR: 6.67, p<0.001), but not presence of comorbidities, medications, or plasma d-dimer value, independently predict postoperative DVT. Subgroup analyses according to the operation site showed that female gender (OR: 3.27, p=0.043) and SV dilatation (OR: 3.72, p=0.022) were independent predictors of postoperative DVT in the THA group. SV dilatation (OR: 12.0, p=0.027) was an independent predictor of postoperative DVT also in the TKA group.
  
  
  
  In addition to gender and TKA, SV dilatation detected by ultrasonography is an independent predictor of DVT after major orthopedic surgery. Determination of SV diameter by ultrasonography before major orthopedic surgery is useful for assessing the risk of postoperative DVT.
authors.affiliation: Division of Laboratory Medicine, Sapporo Medical University Hospital, Sapporo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan. Electronic address: yuda@sapmed.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yuda
authors.affiliation: Division of Laboratory Medicine, Sapporo Medical University Hospital, Sapporo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yasui
authors.affiliation: Division of Laboratory Medicine, Sapporo Medical University Hospital, Sapporo, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Okubo
authors.affiliation: Division of Laboratory Medicine, Sapporo Medical University Hospital, Sapporo, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Muranaka
authors.affiliation: Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ohnishi
authors.affiliation: Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hashimoto
authors.affiliation: Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Teramoto
authors.affiliation: Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagoya
authors.affiliation: Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.affiliation: Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Miura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D057234:Preoperative Period; D018570:Risk Assessment; D012737:Sex Factors; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000209:etiology*
keywords: Deep vein thrombosis; Orthopedic surgery; Soleal vein; Ultrasonography