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Is postoperative anticoagulation necessary after left innominate vein division in general thoracic surgery?
- Source :
-
General thoracic and cardiovascular surgery [Gen Thorac Cardiovasc Surg] 2019 Feb; Vol. 67 (2), pp. 254-258. Date of Electronic Publication: 2018 Oct 29. - Publication Year :
- 2019
-
Abstract
- Objectives: We encounter patients with mediastinal tumors invading the left innominate vein (LIV), and there is no evidence confirming whether the LIV should simply be ligated or reconstructed. The need for postoperative anticoagulant therapy after ligation of LIV is also controversial.<br />Methods: 3209 patients with thoracic malignant tumors underwent surgical resection between 1994 and 2014 in our institute. Nineteen (0.6%) patients had mediastinal malignant tumors invading the LIV and underwent LIV resection. Of these patients, only 3 underwent reconstruction of LIV. We did not start anticoagulant therapy routinely after resection of LIV. The patients were divided into 2 groups: group A showed at least 50% patency of LIV by preoperative contrast-enhanced computed tomography (CECT) and group B showed less than 50%. We investigated the safety of resecting LIV and the need for postoperative anticoagulant therapy.<br />Results: The 30-day and 90-day mortalities were zero in both groups. Thrombosis of the LIV stump and increased edema in the left neck and upper limb were observed in 2 (10.5%) patients only in group A. After initiating the anticoagulant therapy, the embolisms disappeared and weaning the patients off warfarin could be done in less than 1 year.<br />Conclusions: In this study, there was no case of mortality or severe morbidity among the patients with LIV resection. Moreover, there was no need to initiate routine anticoagulant therapy after the LIV division as the frequency of embolism in the LIV stump was low and was expected to disappear prior to starting anticoagulant therapy.
- Subjects :
- Adult
Aged
Aged, 80 and over
Anesthesia
Brachiocephalic Veins diagnostic imaging
Female
Humans
Ligation
Male
Mediastinal Neoplasms diagnostic imaging
Middle Aged
Postoperative Period
Prosthesis Implantation
Retrospective Studies
Risk Factors
Thoracic Surgical Procedures
Tomography, X-Ray Computed methods
Vascular Neoplasms diagnostic imaging
Anticoagulants administration & dosage
Brachiocephalic Veins surgery
Mediastinal Neoplasms surgery
Postoperative Complications prevention & control
Thoracic Surgery
Vascular Neoplasms surgery
Warfarin administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1863-6713
- Volume :
- 67
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- General thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 30374812
- Full Text :
- https://doi.org/10.1007/s11748-018-1019-6