Symptomatic venous thromboembolism after femoral vein harvest

The femoral vein is increasingly utilized as a conduit in major arterial and venous reconstruction. However, perioperative complications, especially venous thromboembolism (VTE) associated with femoral vein harvest (FVH), are not well described. The purpose of this study was to determine the incidence and risk factors for the development of symptomatic VTE in patients who undergo FVH. We conducted a retrospective cohort study of all patients who underwent FVH over a 5-year period at a single institution. Patient clinical characteristics, indications for surgery, postoperative venous duplex scans, and computerized tomography scans of the chest were gathered and reviewed from an electronic medical record query. Statistical analysis was performed to determine which factors correlate with development of perioperative complications after FVH. There were 57 patients (53% male; mean age, 62 years) who underwent 58 FVHs. Of the procedures, 53% were performed for arterial reconstruction and 47% for vascular reconstruction after cancer resection (85% portomesenteric reconstruction). Perioperative VTEs were diagnosed in 17 of 58 (29%) FVH procedures. Sixteen ipsilateral deep vein thromboses (DVTs) occurred distal to the FVH site and five (9%) occurred proximal to the FVH site. The incidence of VTE was significantly greater in patients with malignancy (52% vs 10%; P = .001), and 88% of all VTEs in this series were diagnosed in patients with cancer. All DVTs proximal to the FVH site and all DVTs in the contralateral extremity occurred in patients with malignancy. Pulmonary embolism occurred in two patients. No patients developed compartment syndrome or limb loss. Eight patients (14%) required FVH site wound debridement. VTE after FVH occurs more frequently in patients with malignancy. Aggressive and prolonged thromboprophylaxis and routine venous ultrasound surveillance are warranted after FVH in patients with malignancy.