Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy

Danno, Katsuki; Ikeda, Masataka; Sekimoto, Mitsugu; Sugimoto, Tomoyuki; Takemasa, Ichiro; Yamamoto, Hirofumi; Doki, Yuichiro; Monden, Morito; Mori, Masaki

doi:10.1016/j.surg.2008.06.030

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Volume 145, Issue 5 , Pages 457-464, May 2009

Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy

Katsuki Danno, MD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Masataka Ikeda, MD, PhD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
- Reprint requests: Masataka Ikeda, MD, PhD, Department of Surgery, Graduate School of Medicine, Osaka University, E2-2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Mitsugu Sekimoto, MD, PhD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Tomoyuki Sugimoto, PhD
- Department of Bio-Medical Statistics, Graduate School of Medicine, Osaka University, Suita, Japan
Ichiro Takemasa, MD, PhD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Hirofumi Yamamoto, MD, PhD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Yuichiro Doki, MD, PhD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Morito Monden, MD, PhD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Masaki Mori, MD, PhD
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan

Accepted 23 June 2008.

Background

Splenomegaly is a risk factor for post-splenectomy portal or splenic vein thrombosis (PSVT) due to large splenic vein stump. The relationship between splenic vein diameter (SVD) and PSVT has not been established.

Objectives

To investigate whether SVD is a risk factor for PSVT.

Methods

Forty patients who underwent laparoscopic splenectomy were analyzed. Preoperative and postoperative enhanced helical computed tomographic scans were obtained in all patients, and subsequent follow-up was performed in patients with PSVT during anticoagulant therapy. SVDs at the junction of portal vein (PV) 2, 4, and 6 cm from the junction of PV were measured preoperatively and postoperatively. Multivariate analysis was performed using logistic regression model.

Results

PSVT was diagnosed in 52.5% (21/40) patients. Preoperative SVD was significantly larger in patients with PSVT than in those without PSVT. Seventy-two percent of patients (16/22) with PSVT in splenic veins with a diameter of >8 mm developed PSVT. Multivariate analysis identified preoperative SVD as a significant and independent determinant of PSVT. At a cutoff value of 8 mm, receiver operator characteristic analysis for prediction of PSVT provided an area under the curve of 0.8552 (95% CI 0.821–1.000).

Conclusion

Preoperative SVD is a risk factor for post-splenectomy PSVT. We recommend measurement of SVD preoperatively in patients elected to undergo splenectomy, and a close follow-up of patients with SVD greater than 8 mm.