Evaluation of venous thromboembolic complications in patients operated on for pelvic fracture.

INTRODUCTION: Fractures of the pelvis (acetabulum and pelvic ring) are complex in both radiological diagnosis and therapeutic management. They show high-risk of thrombosis, with variable rates of venous thromboembolic complications in the literature, ranging from 10% to 50%, with 0.5-10% risk of fatal pulmonary embolism. The objective of the present study was to determine the rate of venous thromboembolic events in a consecutive cohort of pelvic fracture and to attempt to identify thromboembolic risk factors in this population. MATERIAL AND METHOD: The study was based on a continuous retrospective series of 120 patients operated on between January 2015 and January 2017. Standard demographic data, clinical and diagnostic data for the fracture and the surgical approach were collected. Risk factors for venous thrombotic episodes were identified on Greenfield Risk Assessment Profile items (age, BMI, cancer, history of venous thromboembolism, surgery time, transfusion, femoral venous catheter, associated fracture) to define groups with high or low thrombotic risk. RESULTS: There was a 5% rate of venous thromboembolic events, and 2.5% of pulmonary embolism including 1 causing intraoperative death. The Greenfield score usually applied in surgery to assess venous thromboembolic risk did not seem relevant in this population already at high-risk of venous thromboembolism. No additional independent risk factors were identified. CONCLUSION: This is the largest cohort focusing on thromboembolic risk in pelvic fracture. The results refine rates reported in the literature. A prospective study, currently underway, should highlight risk factors so as better to prevent these complications.

Femoral vein thrombosis after right-sided electrophysiological procedures.

PURPOSE: Electrophysiological studies and radiofrequency catheter ablations require single or multiple sheath placements through femoral vein cannulation. The objective of this study was to determine the incidence, predictors, and outcomes of deep vein thrombosis (DVT) following such procedures. METHODS AND RESULTS: We prospectively enrolled 220 consecutive patients with a median age of 70 [60-79] years. The median duration of the procedures from insertion to removal of sheaths was 45 [30-75] min. At least two sheaths were inserted in 158 (72%) of the cases. Duplex ultrasonography evaluation of the lower leg veins was performed 6 h after the procedure and revealed common femoral vein thrombosis in 11 (5%) patients. All thrombi were partial and none was complete. Thrombi were mobile in four patients and extended to the external iliac vein in three patients. None of the patients presented with clinical signs of DVT or pulmonary embolism. Anticoagulation was prescribed for 2-4 weeks and a follow-up duplex ultrasonography obtained in the first seven patients revealed complete resolution of thrombi in all cases. On multivariate analysis, two predictors of thrombosis occurrence were identified: a greater sum of sheath diameters (odds ratio, 1.41 [95% confidence interval, 1.25-1.60] per 1-French increase; p < 0.001) and a longer procedural duration (odds ratio, 1.02 [95% confidence interval, 1.00-1.04] per 1-min increase; p = 0.04). CONCLUSIONS: Asymptomatic femoral DVT occur in 5% of electrophysiological studies and right-heart radiofrequency catheter ablations, particularly when large sheaths are inserted for a longer period. The role of anticoagulation in this clinical setting warrants further evaluation.