Dataset Information

Deep Vein Thrombosis after Cement Intravasation during Hip Hemiarthroplasty.

ABSTRACT: Cement intravasation occurs in hemiarthroplasty when pressurization of cement through the medullary canal backflows through the nutrient vessels. This case report describes a 70-year-old woman who underwent hip hemiarthroplasty for a displaced left femoral neck fracture. Postoperative radiographs demonstrated radio-opacity consistent with local cement intravasation. A Doppler ultrasound study subsequently revealed a mobile thrombus at the confluence of the femoral and profunda femoris veins, as well as a nonmobile thrombus within the profunda femoris vein. The more proximal thrombus was determined to be cement that had intravasated during the index operation. The cement likely impeded venous flow, ultimately leading to the development of deep vein thrombosis just distal to the site of cement occlusion.

SUBMITTER: Mathur A

PROVIDER: S-EPMC7303492 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Deep Vein Thrombosis after Cement Intravasation during Hip Hemiarthroplasty.

Mathur Abhay A Fassihi Safa C SC Ramamurti Pradip P Doerre Teresa T

Arthroplasty today 20200413 2

Cement intravasation occurs in hemiarthroplasty when pressurization of cement through the medullary canal backflows through the nutrient vessels. This case report describes a 70-year-old woman who underwent hip hemiarthroplasty for a displaced left femoral neck fracture. Postoperative radiographs demonstrated radio-opacity consistent with local cement intravasation. A Doppler ultrasound study subsequently revealed a mobile thrombus at the confluence of the femoral and profunda femoris veins, as ...[more]

PMID: 32577479

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Project description:BackgroundThe post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome.MethodsWe randomly assigned 692 patients with acute proximal deep-vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting). The primary outcome was development of the post-thrombotic syndrome between 6 and 24 months of follow-up.ResultsBetween 6 and 24 months, there was no significant between-group difference in the percentage of patients with the post-thrombotic syndrome (47% in the pharmacomechanical-thrombolysis group and 48% in the control group; risk ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.11; P=0.56). Pharmacomechanical thrombolysis led to more major bleeding events within 10 days (1.7% vs. 0.3% of patients, P=0.049), but no significant difference in recurrent venous thromboembolism was seen over the 24-month follow-up period (12% in the pharmacomechanical-thrombolysis group and 8% in the control group, P=0.09). Moderate-to-severe post-thrombotic syndrome occurred in 18% of patients in the pharmacomechanical-thrombolysis group versus 24% of those in the control group (risk ratio, 0.73; 95% CI, 0.54 to 0.98; P=0.04). Severity scores for the post-thrombotic syndrome were lower in the pharmacomechanical-thrombolysis group than in the control group at 6, 12, 18, and 24 months of follow-up (P<0.01 for the comparison of the Villalta scores at each time point), but the improvement in quality of life from baseline to 24 months did not differ significantly between the treatment groups.ConclusionsAmong patients with acute proximal deep-vein thrombosis, the addition of pharmacomechanical catheter-directed thrombolysis to anticoagulation did not result in a lower risk of the post-thrombotic syndrome but did result in a higher risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute and others; ATTRACT ClinicalTrials.gov number, NCT00790335 .).

Dataset Information

Deep Vein Thrombosis after Cement Intravasation during Hip Hemiarthroplasty.

Publications

Deep Vein Thrombosis after Cement Intravasation during Hip Hemiarthroplasty.

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