Internal jugular vein thrombosis and pulmonary thromboembolism after head and neck reconstructive surgery

D Kitano; K Yonezawa; S Iwae; S Sakakibara

doi:10.1016/j.bjps.2020.11.007

Internal jugular vein thrombosis and pulmonary thromboembolism after head and neck reconstructive surgery

J Plast Reconstr Aesthet Surg. 2021 Jun;74(6):1239-1245. doi: 10.1016/j.bjps.2020.11.007. Epub 2020 Nov 20.

Authors

D Kitano¹, K Yonezawa², S Iwae², S Sakakibara³

Affiliations

¹ Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-8558, Japan; Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
² Department of Head and Neck Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-0021, Japan.
³ Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-8558, Japan; Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. Electronic address: [email protected].

PMID: 33288470
DOI: 10.1016/j.bjps.2020.11.007

Abstract

Background: Free flap failure secondary to internal jugular vein thrombosis (IJVT) is a significant complication after head and neck reconstructive surgery. A consensus has not yet been reached among reconstructive surgeons regarding the treatment of IJVT.

Methods: We retrospectively evaluated the incidence of IJVT in 118 patients who underwent free flap reconstruction at Hyogo Cancer Center, Akashi, Japan. The occurrence of IJVT-related flap circulation crisis and pulmonary thromboembolism (PTE) was studied. This study was approved by the institutional ethics committee, and written informed consent was obtained from each patient.

Results: From 118 patients who underwent head and neck reconstructive surgery, we included 116 internal jugular veins (IJVs) preserved after neck dissection in the present study. IJVT was confirmed in 25 (21.6%) IJVs from 23 patients. One patient (0.8%) developed venous congestion due to IJVT, which resulted in total flap necrosis. Two patients (1.7%) exhibited PTE associated with IJVT. They were treated with direct oral anticoagulants for 3 months and were discharged without any sequelae.

Conclusion: Our results suggest that IJVT after head and neck reconstructive surgery caused not only flap circulation crisis but also PTE. Reconstructive surgeons should be aware of the potential risks due to serious complications associated with IJVT.

Keywords: Direct oral anticoagulants; Internal jugular vein thrombosis; Neck dissection; Pulmonary thromboembolism; Reconstructive surgery.

MeSH terms

Factor Xa Inhibitors / administration & dosage
Female
Free Tissue Flaps* / adverse effects
Free Tissue Flaps* / blood supply
Head and Neck Neoplasms / surgery
Humans
Incidence
Japan / epidemiology
Jugular Veins* / diagnostic imaging
Jugular Veins* / pathology
Male
Middle Aged
Neck Dissection* / adverse effects
Neck Dissection* / methods
Outcome and Process Assessment, Health Care
Plastic Surgery Procedures* / adverse effects
Plastic Surgery Procedures* / methods
Postoperative Complications* / physiopathology
Postoperative Complications* / therapy
Pulmonary Embolism* / diagnosis
Pulmonary Embolism* / drug therapy
Pulmonary Embolism* / etiology
Retrospective Studies
Risk Adjustment / methods
Venous Thrombosis* / drug therapy
Venous Thrombosis* / epidemiology
Venous Thrombosis* / etiology
Venous Thrombosis* / physiopathology

Substances

Factor Xa Inhibitors