Takahashi T, et al. - The researchers examined the incidence of upper extremity deep vein thrombosis (UEDVT) after esophagectomy and the risk factors associated with UEDVT. For UEDVT, retrosternal reconstruction could be a risk factor. Retrosternal reconstruction could be inappropriate in patients with the small width of the retrosternal space.

Methods

• A total of 88 patients who underwent esophagectomy with retrosternal or posterior mediastinal reconstruction using gastric tube were included.
• Using postoperative contrast-enhanced computed tomography (CT), the researchers measured the incidence of UEDVT and the diameter of the left brachiocephalic vein.
• Measurements were carried out in terms of:
  • (a) The distance from sternum to brachiocephalic artery
  • (b) The distance from sternum to vertebra were measured by preoperative CT,
  • The ratio of (a) to (b) was defined as the width of the retrosternal space.

Results

• Out of 88 patients, 14 (15.9%) suffered from UEDVT.
• The researchers found all UEDVTs in left-side upper extremity deep veins.
• In this study, 12/14 patients (85.7%) underwent retrosternal reconstruction.
• An independent risk factor for UEDVT was retrosternal reconstruction (odds ratio 5.48) in a multivariate analysis.
• In patients with retrosternal reconstruction, the diameter of the left brachiocephalic vein was significantly smaller than that in patients with posterior mediastinal reconstruction (4.3 vs 6.9 mm; P < 0.001) because of compression of left brachiocephalic vein by the gastric tube.
• In patients with UEDVT, the width of the retrosternal space was significantly smaller than that in patients without UEDVT (0.21 vs 0.27; P=0.001) among patients with retrosternal reconstruction.