Venous Thromboembolism Following Foot and Ankle Surgery

A Case Series of Two Tertiary Medical Centers and a Review of the Literature

Orfan Arafah, FRCSC; Khalifah Aldawsari, MBBS; Mohammed Alsubaie, MBBS; Khaled Alshehri, MBBS; Albaraa Sayed, MBBS

Disclosures

Curr Orthop Pract. 2020;31(1):76-79. 

In This Article

Abstract and Introduction

Abstract

Venous thromboembolism (VTE) is a serious medical concern after surgical interventions. The overall incidence of clinically symptomatic VTE after foot and ankle surgery is considered to be low. However, there are limited data on the actual incidence of symptomatic VTE after foot and ankle surgery especially in our region. The purpose of this study was to determine the incidence of clinically symptomatic VTE after foot and ankle surgery in two tertiary medical centers and to review the most recent literature on VTE incidence, risk factors, and prophylaxis after foot and ankle surgery. This study is divided into two parts: a retrospective case series and a review of the literature from 2017 to 2018. A retrospective review was performed of patients who underwent foot or ankle surgery in two tertiary medical centers in Riyadh, Saudi Arabia for 3 consecutive years. Patients 18 yr of age and older were included. The patients' demographic data (age, gender, body mass index [BMI]), medical comorbidities (diabetes mellitus [DM] and hypertension [HTN]), type of procedure, and the use of prophylaxis were obtained from the medical records. The incidence of clinically symptomatic VTE was determined based on the 90-days follow-up and/or the radiographic report. All of the information was then confirmed by calling patients on the phone. Data were entered and analyzed. Out of 125 patients, 69 (55.2%) were female and 56 (44.8%) were male. Patients had a mean age of 38.7 yr and a BMI of 28.11 kg/m2. The incidence of clinically symptomatic VTE was 0.8% (one out of 125), diagnosed in a 39-year-old male who was medically cleared and not on prophylaxis. Symptomatic deep vein thrombosis was confirmed by the radiographic report. The incidence of symptomatic VTE after foot and ankle surgery appeared to be low (less than 1%). The decision to prescribe thromboprophylaxis should be based on individual factors and characteristics.

Level of Evidence: Level IV.

Introduction

Venous thromboembolism (VTE) is a serious condition that often presents as deep venous thrombosis (DVT) and/or pulmonary embolism (PE). VTE is a concerning medical complication after surgical procedures, causing significant morbidity.[1] In England 25,000 people die every year because of VTE. Mortality from VTE is considered to be more than breast cancer, road traffic accidents, and acquired immune deficiency syndrome all combined together.[2] An imbalance in thrombin activity might be the underlying mechanism for VTE that can be expressed through Virchow's triad, which has three elements: venous stasis, endothelial injury, and hypercoagulability.[3,4] Postoperative immobilization decreases the venous backflow in lower extremities, and use of an intraoperative tourniquet might also aggravate the venous stasis. The nature of surgical procedures interferes with the vascular endothelium, and hypercoagulability can exist due to several factors, such as the stress of the surgery, bedrest after the surgery, or even the trauma itself.[5–8] Lower extremity surgeries are a potential risk factor for developing VTE, and the literature regarding hip and knee surgeries is well-researched in terms of postoperative VTE incidence and its related risk factors and the role of prophylaxis.[9–11] However, in the field of foot and ankle surgery, the literature about the incidence of VTE after surgery and the related risk factors is still unclear.

The aims of this study were to determine the incidence of clinically symptomatic VTE after foot and ankle surgery in two tertiary medical centers and to review the most recent literature regarding VTE incidence, risk factors, and prophylaxis after foot and ankle surgery.

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