Background/Aim: Ultrasonographic assessment of venous vessels of low extremities before and after endoprosthesis replacement of knee joint is essential for early detection of venous thrombosis and prevention of pulmonary embolism. In spite of thromboprophylaxis occurrence of deep veins thrombosis and pulmonary embolism remain to be high (up to 19-37% and 10%, respectively). In this study we decided to analyze if sonographic monitoring of venous vessels can help to diminish pulmonary embolism after surgery.
Methods: Primary knee replacement was performed in 202 (99.0%) patients. Bilateral knee prosthetic arthroplasty was used in 40 (19.6%) patients. In all cases triplex sonography of lower extremities veins was performed before surgery, in 7-10 days and 2.5-3 months after surgery. For sonography ultrasound machines Aspen (Siemens) and MicroMax (SonoSite) were applied. On the base of obtained sonographic data individualized combinations of specific and nonspecific methods of thromboprophylaxis were used in perioperative period.
Results: Preliminary triplex sonography revealed varicose disease of low extremities in 45% of patients. All subjects with varicose transformation underwent phlebectomy before knee replacement. Accidentally in 2 patients floating thrombi were detected in superficial femoral vein; urgent thrombectomies were performed. In 7 days after surgery in 8 (4 %) patients floating thrombi were detected in tibia-popliteal segment, in 3 (1.5%) cases there were thromboses of femoral veins. In all patients thrombectomies were performed.
Pulmonary embolism of minor branches of pulmonary artery was detected only in 2 (1%) patients early after surgery; critical care therapy allowed keeping off fatal complications. In 6 (3 %) patients clinically significant thrombosis of deep veins appeared during first month after surgery. Asymptomatic not dangerous tibial deep veins thrombosis was diagnosed in 12 (6%) patients in 2.3-3 months after surgery by triplex sonography.
Conclusion: Sonographic monitoring of lower extremities venous vessels in patients with endoprosthesis replacement of knee joint gives opportunity to optimize thromboprophylaxis, significantly diminish frequency of nonfatal and avoid fatal pulmonary embolism.
