Impact of venorrhaphy and vein ligation in isolated lower extremity venous injuries on venous thromboembolism and edema

INTRODUCTION Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it potentially risks extremity edema. The purpose of this study was to evaluate the management of venous injury on VTE and extremity edema in patients with isolated lower extremity venous injuries. METHODS Patients with common iliac, external iliac and femoral venous injuries over a 10-year period were stratified by age, shock, management of venous injury, injury severity, and timing and type of anticoagulation. Outcomes included development of extremity edema and VTE (pulmonary embolism (PE), deep venous thrombosis (DVT)). Outcomes were then evaluated to determine risk factors for symptomatic lower extremity edema and VTE by the management of venous injuries. RESULTS 84 patients were identified: 20 common iliac, 27 external iliac, 37 femoral. 49 underwent vein repair and 35 underwent vein ligation. 93% were male with a mean ISS and GCS of 17 and 14. VTE occurred in 18 (21%); 15 (18%) DVT and 4 (5%) PE. 32 patients (38%) developed lower extremity edema. Those who underwent vein ligation had a greater degree of shock on presentation (RBC transfusions, 14 vs 8 units, p=0.03) and were more likely to receive prophylactic fasciotomies (60% vs 33%, p=0.01). There was no difference in time to or type of chemoprophylaxis between patients who underwent vein repair and those who received vein ligation. However, patients with vein ligation had fewer episodes of VTE (9% vs 31%, p=0.02) with no difference in symptomatic lower extremity edema (37% vs 39%, p=0.88) or amputation rates (0% vs 2%, p=0.99). CONCLUSIONS Vein repair had a higher incidence of VTE while providing no additional benefit in reducing symptomatic extremity edema compared to ligation in patients suffering venous injury. Ligation of most extremity venous injuries can be performed without increasing patient morbidity. LEVEL OF EVIDENCE Level III, retrospective study. Correspondence: Nathan R. Manley, MD, MPH, 910 Madison Avenue, 2nd Floor, Memphis, Tennessee 38163, Phone: 901-448-8140, Fax: 901-448-8472. Email: nmanley1@uthsc.edu No conflict of interests to declare. No disclosure on funding to declare. 76th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery, September 13-16, 2017, Baltimore, MD © 2017 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2zV04Mr