Massive acute pulmonary embolism after venous ligations for varicose veins

Abstract

We experienced a case of emergency pulmonary embolectomy for acute pulmonary embolism after venous ligations for primary varicose veins. A 58-year-old woman visited our outpatient clinic for left short saphenous type varicose veins with heaviness and swelling in her legs, and was treated with duplex scan oriented venous ligations. She noticed dyspnea on the fifth POD and came to the hospital on the seventh POD. Duplex scan examination showed thrombus at the stump of the SPJ and deep vein thrombosis in the left leg, and echocardiography revealed the floating thrombus in the right atrium and the right ventricle dilatation. Contrast enhanced CT scanning identified a shadow defect by embolus in a pulmonary artery. Under the diagnosis of pulmonary embolism due to deep venous thrombosis of the left leg, emergent embolectomy was performed and IVC filter was also inserted. The patient recovered uneventfully.

The frequency of postoperative deep venous thrombosis after surgery for varicose veins in our hospital is 0.1%, and it is thought that this is a very rare case accompanied with life-threatening pulmonary embolism. It is important to construct the emergency system for severe complications such as pulmonary embolism, because day surgery will be done broadly and less invasive surgery such as venous ligations involves risk of DVT.