Incidence of Upper Extremity Deep Vein Thrombosis After Esophagectomy

According to a report, published in BMC Surgery, the occurrence of upper extremity deep vein thrombosis (UEDVT) has increased due to central venous catheter (CVC), cancer, and surgical invasion; However, lead author Leo Yamada and colleagues felt that information on UEDVT in esophagectomy for cancer is limited. They performed a study to assess clinical factors that could serve as predictive markers for UEDVT in patients undergoing esophagectomy and reported that “the existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.”

The study assessed UEDVT in a total of 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. Assessments were dong using routine contrast-enhanced computed tomography (CT) on the fourth day after surgery. Low-molecular-weight-heparin (LMWH) was also routinely administered starting by the second postoperative day. The width of the retrosternal space was defined as the ratio between the sternum to brachiocephalic artery distance and the sternum to vertebra distance.

In the cohort, 11 (16.7%) patients suffered from UEDVT, among which zero had received preoperative CVC placement. The authors noted that seven CVCs had been installed in non-UEDVT patients. The retrosternal space width in patients who developed UEDVT was significantly smaller than the width in patients without UEDVT (0.17 vs. 0.26; p <0.0001). After analysis, the authors presented a cutoff value of 0.21 for retrosternal space width, which they calculated had 87% sensitivity and 82% specificity for predicting UEDVT.

Ultimately, the authors judged that the occurrence of UEDVT was “not rare” in patients who underwent esophagectomy with retrosternal reconstruction, however, “unlike other diseases, the width of retrosternal space, not the existence of CVC, is responsible for the development of UEDVT” in this population.