title: Increased Lower Extremity Venous Stasis May Contribute to Deep Venous Thrombosis Formation after Microsurgical Breast Reconstruction-An Ultrasonographic Study.
abstract: BackgroundDespite guideline-compliant prophylaxis, an increased rate of deep venous thrombosis (DVT) formation has been reported following autologous versus implant-based breast reconstruction. We hypothesized that tight abdominal fascia closure might decrease lower extremity venous return and promote venous stasis.MethodsAn observational crossover study of patients who underwent autologous breast reconstruction using transverse rectus abdominis musculocutaneous/deep inferior epigastric artery perforator flaps was conducted. Ultrasonographic measurements of the left common femoral vein (CFV) and right internal jugular vein (IJV) were performed preoperatively, in the postanesthesia care unit, and on postoperative day (POD) 1. Parameters of interest included vessel diameter, circumference, area, and maximum flow velocity.ResultsEighteen patients with a mean age and body mass index of 52.7 years (range, 29-76 years) and 31.3 kg/m2(range, 21.9-43.4 kg/m2) were included, respectively. A 29.8% increase in CFV diameter was observed on POD 1 (p< 0.0001). Similarly, a 24.3 and 69.9% increase in CFV circumference (p= 0.0007) and area (p< 0.0001) were noted, respectively. These correlated with a 28.4% decrease in maximum flow velocity in the CFV (p= 0.0001). Of note, none of these parameters displayed significant changes for the IJV, thus indicating that observed changes in the CFV were not the result of changes in perioperative fluid status.ConclusionPostoperative changes observed in the CFV reflect increased lower extremity venous stasis after microsurgical breast reconstruction and may contribute to postoperative DVT formation.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California.
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tecce
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Lanni
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.
authors.forename: Shagun
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Division of Plastic Surgery, University of Utah, Salt Lake City, Utah.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pannucci
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.
authors.forename: Suhail K
authors.initials: SK
authors.lastname: Kanchwala
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
authors.affiliation: Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D018592:Cross-Over Studies; D019074:Epigastric Arteries / Q000503:physiopathology; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D006487:Hemostasis; D006801:Humans; D035002:Lower Extremity / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016462:Mammaplasty / Q000009:adverse effects; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation; D013524:Surgical Flaps / Q000098:blood supply*; D016217:Ultrasonography, Mammary; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control