The risk of deep vein thrombosis (DVT) is well studied for some orthopedic surgery. However, the incidence of postoperative DVT is less well-defined in patients who have spinal surgery. In addition, there is insufficient evidence to suggest that screening patients before spinal surgery and to use of prophylactic method such as anticoagulants, compression stockings, and pneumatic compression device. We experienced a 78-year-old female patient of DVT after fusion operation with pedicular screws in T12 osteoporotic compression fracture. As risk of DVT after major spinal surgery is fairly low, it seems reasonable to consider prophylactic management after spinal surgery in old aged patients with difficult ambulation.
Aged ; Anticoagulants ; Female ; Fractures, Compression ; Humans ; Incidence ; Mass Screening ; Orthopedics ; Stockings, Compression ; Venous Thrombosis ; Walking

BACKGROUND: The sitting position under general anesthesia is associated with hemodynamic instability. The purpose of this study was to compare the efficacy of a sequential compression device (SCD) with that of elastic stockings (ES) in reducing the incidence of hypotension and other hemodynamic instability in the sitting position during shoulder arthroscopy. METHODS: Fifty-one patients undergoing shoulder arthroscopy were randomly assigned into one of three groups to receive no treatment (control group, n = 17), SCD (SCD group, n = 17) or ES (ES group, n = 17). Hemodynamic variables were measured 5 min after induction of anesthesia (baseline values), and every 1 min from 1 to 5 min after raising the patient to a 70degrees sitting position (T1-5) with the beach-chair. RESULTS: The incidences of hypotension (proportion, 95% CI) were 12/17 (0.71, 0.47-0.87), 5/16 (0.31, 0.14-0.56) and 7/15 (0.47, 0.25-0.70) in the control, SCD and ES group, respectively. The incidence was significantly lower in the SCD group than that in the control group (P = 0.038). At 1 min after sitting position, mean arterial pressure in the control group was significantly lower than that in the SCD group and it was significantly decreased from the baseline value. CONCLUSIONS: SCD could significantly reduce the incidence of hypotension with less hemodynamic instability in the sitting position during shoulder arthroscopy. Although the incidence of hypotension was decreased with the elastic stocking, there was no statistical significance.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Arthroscopy ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Shoulder ; Stockings, Compression

PURPOSE: To know the effect of elastic stocking on reducing edema and preventing deep vein thrombosis(DVT) after total knee arthroplasty(TKA). MATERIALS AND METHODS: One hundred patients who had received simultaneous bilateral TKA was prospectively evaluated. One extremity was accoutered with elastic stocking while the other, not. The lower extremity circumference was measured at postopertive 2, 5, 7 and 10 days. The patient's satisfaction was asked by means of a questionnaire. We evaluated the DVT case also. RESULTS: The thigh and calf circumferences of elastic stocking side were average 0.70 cm and 0.58 cm shorter than those of non-stocking side, this was found to be statiscally insignificant(p>0.05). Satisfaction rate was 76%. One case of DVT occurred in each of the two groups. CONCLUSION: Elastic stocking application after TKA cannot be expected to reduce lower extremity edema or to prevent DVT. However, the satisfaction rate was high.
Arthroplasty* ; Edema ; Extremities ; Humans ; Knee* ; Lower Extremity ; Prospective Studies ; Surveys and Questionnaires ; Stockings, Compression* ; Thigh ; Veins

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.
Critical Care ; Critical Illness ; Diagnosis ; Humans ; Incidence ; Critical Care ; Intermittent Pneumatic Compression Devices ; Male ; Pilot Projects* ; Stockings, Compression* ; Venous Thrombosis*

BACKGROUND: We hypothesized that intermittent pneumatic compression device (IPCD) compression system might induce more decreases on the core temperature by increasing the lower extremity blood flow. This study investigated the effects of IPCD compression system on the body temperature in patients undergoing minor surgery under propofol-remifentanil anesthesia. METHODS: Forty female patients were randomly assigned to treat with either elastic stockings (ES group, n = 20) or IPCD (IPCD group, n = 20). Anesthesia was induced and maintained with propofol and remifentanil. The core temperature and arteriovenous shunt in the lower leg were measured using esophageal temperature and the calf to toe skin-surface temperature gradient, respectively. The measurements were taken at 15-minute intervals immediately after anesthesia induction (baseline values, T0) until the end of the surgery. RESULTS: During the study period, the core temperature and skin temperature gradient were comparable between the two groups. The core temperature decreased from 60 min in both groups. And, skin-surface temperature gradient decreased from 15 min in the IPCD group and 30 min in the ES group after anesthesia induction, without intergroup differences across time. CONCLUSIONS: This study demonstrated that the IPCD system did not affect the change in the core temperature when compared to the ES, in patients undergoing minor surgery during propofolremifentanil anesthesia. Thus, the IPCD system could be safely used during propofol-remifentanil anesthesia, without increasing the risk of the intraoperative hypothermia.
Anesthesia ; Body Temperature ; Female ; Humans ; Hypothermia ; Leg ; Lower Extremity ; Piperidines ; Propofol ; Skin Temperature ; Stockings, Compression ; Surgical Procedures, Minor ; Toes

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

PURPOSE: To determine the risk factors of delayed recanalization of isolated calf vein thrombosis (CVT). METHODS: One hundred fifty limbs of 110 patients with CVT between September 2007 and April 2010 were enrolled. We used ultrasonography for the diagnosis and follow-up examinations of CVT. We calculated recanalization rates at 1 and 3 months after initial diagnosis and analyzed the risk factors associated with delayed recanalization of CVT. RESULTS: CVTs were located in the muscular calf vein in 110 (73.3%), in the deep calf vein in 18 (12%), and in both in 22 cases (14.7%). Among all CVTs, 94 limbs (63%) were symptomatic. Major risk factors for CVT were orthopedic surgery (87.3%), malignancy (21.3%), and immobilization (15.3%). Sixty-seven patients (60.9%) were treated with oral anticoagulation therapy, while 43 patients by low molecular weight heparin (n = 19) or by conservative methods including elastic compression stockings and ambulation (n = 21). The cumulative recanalization rate at 1 and 3 months was 23% and 82% and it was significantly higher in patients who underwent oral anticoagulation therapy compared with patients without oral anticoagulation therapy (84% vs. 65%, P = 0.008 by log-rank test). Malignancy (odds ratio [OR], 2.789; P = 0.043) and immobilization (OR, 4.191; P = 0.029) were independent risk factors for delayed recanalization of CVT and oral anticoagulation (OR, 0.300; P = 0.020) was an independent factor in promoting recanalization in multivariate analysis. CONCLUSION: For patients with isolated CVT, no oral anticoagulation resulted in higher rates of delayed recanalization compared to oral anticoagulation treatment. Immobilization and having malignancy were independent risk factors for delayed recanalization.
Extremities ; Follow-Up Studies ; Heparin, Low-Molecular-Weight ; Humans ; Immobilization ; Orthopedics ; Risk Factors ; Stockings, Compression ; Thrombosis ; Veins ; Venous Thrombosis ; Walking

OBJECTIVE: Venous thromboembolism (VTE) after spinal surgery affects a patients' postoperative recovery and also carries a mortality risk. Some studies recommended chemical prophylaxis for high-risk patients and for those after complex spinal surgeries. However, chemoprophylaxis for VTE in spinal surgery is underemployed and there is no agreement on the use of VTE prophylaxis in spinal surgery. The aim of this study was to document the incidence of VTE after an elective instrumental spinal surgery, among those receiving preoperative chemoprophylaxis as compared with patients who did not receive it. METHODS: This study was carried out on eighty-nine patients allocated randomly to receive either low molecular weight heparin (LMWH) or no prophylaxis before elective instrumental spinal surgery. All patients received postoperative compression stockings. A compression Doppler ultrasonography was performed for all patients to detect postoperative deep vein thrombosis. In addition, further imaging studies were performed for patients suspected of VTE. RESULTS: Three (3.3%) patients were diagnosed with VTE. One of them had received preoperative chemoprophylaxis. There were no significant difference in incidence of VTE between the two groups (p>0.95; 95% confidence interval, 0.06-8.7). Laterality of gender and postsurgical recumbence duration were all independent predictors of VTE (p=0.01 and p<0.001, respectively). CONCLUSION: The difference in the incidence of thromboembolic complications between the two groups was not significant. Moreover, we found that preoperative prophylactic LMWH injection has no major bleeding complications altering postoperative course; still, the issue concerning the initiation time of chemoprophylaxis in spinal surgery remains unclear.
Chemoprevention* ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Humans ; Incidence* ; Mortality ; Pulmonary Embolism ; Stockings, Compression ; Ultrasonography, Doppler ; Venous Thromboembolism ; Venous Thrombosis

BACKGROUND: Among various measures to prevent deep venous thrombosis (DVT) in surgical patients, intermittent pneumatic compression of the legs is known to be effective without increasing the risk of bleeding. In this study, the coagulation/ fibrinolysis profile in patients undergoing gastrectomy with SCD Response Compression System, which detects individual venous refill time, was compared to that with elastic stocking using thromboelastography (TEG). METHODS: Fifty-eight ASA class I-II patients undergoing gastrectomy were randomized into two groups. Patients in ES group (n = 29) were treated with elastic stocking and patients in SCD group (n = 29) were treated with SCD Response Compression System. TEG analysis and traditional coagulation tests were performed on arrival in the operating room, after surgery in the postanesthetic care unit and on the morning of postoperative day 1. RESULTS: There was no significant difference in laboratory data between the two groups. Laboratory data at all time points were within normal limit in all patients. There was no significant difference in TEG data between the two groups. No evidence of a postoperative clinical coagulopathy (DVT or pulmonary embolism) was observed on routine history and physical examinations in any patient during hospitalization. CONCLUSIONS: The effectiveness of SCD Response Compression System in patients undergoing major abdominal surgery on coagulation/fibrinolysis system was similar to that of elastic stocking during perioperative period.
Fibrinolysis* ; Gastrectomy* ; Hemorrhage ; Hospitalization ; Humans ; Leg ; Operating Rooms ; Perioperative Period ; Physical Examination ; Stockings, Compression* ; Thrombelastography* ; Venous Thrombosis

The purpose of this study was to understand the general features of pulmonary embolism in neurosurgical patients. The authors retrospectively reviewed 24 cases of pulmonary embolism from 1981 to 1994. The overall incidence of pulmonary embolism was 0.2%, but in the most prevalent year(194) it was 1.3%. Lower extremity weakness and immobilization was the most common predisposing condition. Of 24 patients with pulmonary embolism, 23 patients showed lower extremity weakness, and the mean duration of immobilization was 47 days. Most patients(80%) had symptoms of pulmonary embolism within 4 weks after operation. Medical prophylactic method had not been used in patients other than physical prophylactic method-graduated compression stocking, position change or physical therapy. Heparinization was given to 18 patients(75%), and minor hemorrhagic complication developed in 2 patients, but no major bleeding occurred. Inferior vena cava filter was applied in 2 patients. Only one patient suffered from recurrence and it w as not fatal. Of the 24 patients, 7 died, however only one patient died of pulmonary embolism. In our study, the prognosis of pulmonary embolism was not as serious as it has been reported in the literature. However, more precise studies will be needed to understand the fate of pulmonary embolism in Korean neurosurgical patients.
Hemorrhage ; Heparin ; Humans ; Immobilization ; Incidence ; Lower Extremity ; Neurosurgery ; Prognosis ; Pulmonary Embolism* ; Recurrence ; Retrospective Studies ; Stockings, Compression ; Vena Cava Filters