Investigators found that untreated varicose veins put patients at greater risk for DVT after THA.
SAN FRANCISCO — Researchers have found increased rates of deep vein
thrombosis within 90 days of total hip arthroplasty among patients with
untreated varicose veins.
“Overall, patients should consider having their varicose veins
treated prior to undergoing total hip arthroplasty in an attempt to reduce
[deep vein thrombosis] DVT,” Anahita Dua, MD, of Brookfield, Wisc., said
at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, here.
However, Dua and colleagues did not find a connection between DVT risk
and untreated varicose veins for patients undergoing total knee arthroplasty
(TKA). They also found no link between untreated varicose veins and pulmonary
embolism (PE) risk with either TKA or total hip arthroplasty (THA).
A paucity of data in this area and a single study in the Romanian
literature that described removal of varicose veins as being associated with
decreased postoperative DVT rates for TKA, inspired Dua and her Scottish
colleagues to study this topic in more depth.
“Every textbook from medical school all the way up states that
varicose veins are a risk factor for DVT, but it has never been
quantified,” Dua told Orthopedics Today. “No one tells you how
much of a risk factor and, if it is a risk factor, then why are we not doing
something about it? It is such an easy thing to take care of.”
Dua and colleagues examined records in the Scottish Arthroplasty
Register to identify 57,367 patients who underwent THA and 51,859 patients who
underwent TKA between 1989 and 2009. They then searched for corresponding DVT
and PE events in the same study population using the Scottish Morbidity
Database. In addition, they identified records of a varicose vein diagnosis and
treatment in the THA and TKA populations.
The researchers used a clinical, etiologic, anatomic and
pathophysiologic (CEAP) classification score of >2 as the cut off for a
positive varicose vein diagnosis, Dua said at the meeting.
Among the THA group, investigators found that DVT rates were both 0.8%
for patients with no history of varicose veins and for those diagnosed with the
condition who underwent surgery for the veins.
However, patients who had a varicose vein diagnosis and no documented
operation for this prior to the joint reconstruction procedure had a 3.1% rate
of DVT — a difference that was statistically significant.
“Untreated varicose veins are associated with increased rates of
DVT in patients with THA,” Dua, a general surgery resident at the Medical
College of Wisconsin, said in her presentation.
Dua and her colleagues did not observe any greater PE rates within 90
days following THA with untreated varicose veins. The 53,659 patients studied
who had no previous varicose vein diagnosis or varicose vein surgeries had a
0.7% PE rate within 90 days of undergoing THA. This was the same rate observed
among the 3,478 THA patients with a previous diagnosis and surgery for varicose
In comparison, the PE rate was 0.4% for the 227 patients who had a
varicose vein diagnosis and no varicose vein surgery prior to undergoing THA.
The researchers also found no relationship between the incidence and
treatment of varicose veins and the risk of thromboembolic events 90 days
The study limitations, Dua said at the meeting, included short follow-up
and the fact that researchers were unable to determine whether varicose veins
recurred in those patients who underwent an intervention for them.
Dua told Orthopedics Today that the data do not provide answers
regarding when varicose vein interventions should be completed rather that
varicose veins should be considered when determining which factors can decrease
a patient’s DVT risk postoperatively.
“For that you need further randomized trials, and they need to be
done in a controlled fashion. They need to include every patient undergoing a
systematic, similar anticoagulation profile [with the] variables controlled.
Everyone gets an ultrasound. You have to … define what a DVT is and what a
varicose vein is defined as in your study. That is the basis of future research
work, but you can at least justify doing that study now that you have this one
to say there is evidence that managing varicose veins prior to THA could, in
fact, reduce DVT.” – by Susan M. Rapp
For more information:
- 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.
- Ruxanda A, Grecu D, Surlin V, et al. [Lower limb varicosity in
patients, with indication for total knee arthroplasty]. Chirurgia (Bucur).
- Anahita Dua, MD, can be reached at Medical College of Wisconsin,
8701 Watertown Plank Rd., Milwaukee, WI 53226; 262-565-8247; email:
- Disclosure: Dua has no relevant financial disclosures.