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Untreated varicose veins put patients at greater DVT risk following THA

Issue: May 25, 2012

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SAN FRANCISCO — As the search continues for methods to reduce deep vein thrombosis and pulmonary embolism risk in patients undergoing total joint arthroplasty, researchers have found increased rates of deep vein thrombosis within 90 days of undergoing total hip arthroplasty among patients with untreated varicose veins.

“Overall patients should consider having their varicose veins treated prior to undergoing total hip arthroplasty (THA) in an attempt to reduce DVT [deep vein thrombosis],” Anahita Dua, MD, of Brookfield, Wisc., said at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, here.

For 57,367 patients who underwent THA and 51,859 patients who underwent total knee arhroplasty (TKA) between 1989 and 2009 with records in the Scottish Arthroplasty Register, researchers identified corresponding DVT and pulmonary embolism (PE) events using the Scottish Morbidity Database. They also searched for records of varicose vein diagnosis and any treatment.

For THA, DVT rates were 0.8% for patients who had never had varicose veins and or who were diagnosed with them but had undergone a recorded surgery. However, the patients who had a varicose veins diagnosis but no documented operation had a 3.1% rate of DVT. Dua said her team did not show the same association of greater PE rates following THA with untreated varicose veins.

The researchers also studied the rates of DVT and PE in patients at 90 days following TKA to identify any relationship between varicose vein incidence and treatment and risk of thromboembolic events, but found none, she said.

Among the study weaknesses, she said, were short follow-up and that researchers were unable to determine if varicose veins recurred in patients who underwent an intervention.

Reference:

• Dua A, Nieva SS, Sutherland AG. Is previous varicose vein surgery associated with deep vein thrombosis within 90 days of hip and knee replacement? Paper #32. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
• Disclosure: Dua has no relevant financial disclosures.

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