Deep Vein Thrombosis after Surgery for Gastrointestinal Cancer: Incidence and Correlation with Risk Factors

PURPOSE: Deep vein thrombosis (DVT) is recognized as a common complication in surgical patients in western countries, and especially for high risk patients. However there is little informations on the incidence and risk factors of DVT after gastrointestinal cancer surgery in Korea. The aim of this study is to evaluate the incidence and risk factors of DVT after gastrointestinal cancer surgery that is performed without antithrombotic prophylaxis. METHOD: From August 2003 to February 2004, 107 patients who underwent gastrointestinal cancer surgery were evaluated prospectively. Hypercoagulability studies were done before the operation or before any blood transfusion, and the other clinical risk factors were also examined. All the patients were examined between the 5th and 10th postoperative day with duplex ultrasonographic assessment of both lower extremities. RESULT: DVT was found in 8 patients (7.5%) and two patients had symptomatic DVT. Five patients showed thrombi in there calf veins, two patients in the popliteal vein, and one patient in the iliac vein. The DVT group showed a significantly higher incidence of hyperhomocysteinemia than non-DVT group. There was no statistically significant difference between the DVT and non-DVT group according to other risk factors. CONCLUSION: The incidence of DVT after intra-abdominal cancer surgery in Koreans is significantly lower than for the patients in western countries. Considering the lower rate of proximal DVT, routine prophylaxis for DVT appears to be unwarranted in Koreans before and after intra-abdominal cancer surgery. Finally we did not identify a correlation between DVT and the so-call risk factors except for hyperhomocysteinemia. It would be interesting to perform further studies to clarify the association between hyperhomocysteinemia and DVT in cancer patients.

Central Venous Catheterization Via Persistent Left Superior Vena Cava

Although the use of central venous cannulation has been increasing in recent years, it can produce serious complications such as hemothorax, pneumothorax, arterial puncture, and malposition of the catheter. Therefore, post-procedure chest radiograph must be obtained to confirm correct placement of the catheter and to exclude pneumothorax or hemothorax. We experienced an abnormal course of left subclavian catheter along the left border of the heart on post-procedure chest radiograph. Here we report a case of persistent left superior vena cava detected by hemodialysis catheterization in a patient with acute renal failure after ruptured abdominal aortic aneurysm.

Deep Vein Thrombosis Casused by Congenital Absence of Inferior Vena Cava Combined with Hyperhomocysteinemia Due to C677T Methylenetetrahydrofolate Reductase Homozygos Mutation

We present a case of suprarenal & infrarenal absence of inferior vena cava combined with hyperhomocysteinemia in a 39-year-old woman who presented with symptoms of deep venous thrombosis. The patient has also C677T methylenetetrahydrofolate reductase homozygous mutation. Deep vein thrombosis has multifactorial etiology involving both genetic and acquired factors. Absence of inferior vena cava is a rare congenital anomaly, but recently it was confirmed as important risk factor for the development of deep vein thrombosis especially young person. Hypercoagulability by the hyperhomocysteinemia with suggested tendency to venous stasis mediated by agenesis of inferior vena cava must have caused the deep vein thrombosis in our patient. To our knowledge, such an association has not been reported. Clinical features and prognosis of this entity are discussed.