Education  |   August 2019
Femoral Vein Thrombus Diagnosed during Ultrasound-guided Femoral Nerve Catheter Placement
Author Notes
  • From the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, and the University of Ottawa, Ontario, Canada (T.R.S., P.R., C.J.L.M.); and the University of Sydney, New South Wales, Australia (T.R.S.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • This case was presented as a case report abstract for the American Society of Regional Anesthesia and Pain Medicine 2019 meeting in Las Vegas, Nevada, April 11 to 13, 2019.
    This case was presented as a case report abstract for the American Society of Regional Anesthesia and Pain Medicine 2019 meeting in Las Vegas, Nevada, April 11 to 13, 2019.×
  • The image was not included in the submission and remains novel.
    The image was not included in the submission and remains novel.×
  • Address correspondence to Dr. Sullivan: drtimothyrichmondsullivan@gmail.com
Article Information
Education / Images in Anesthesiology / Central and Peripheral Nervous Systems / Radiological and Other Imaging / Technology / Equipment / Monitoring
Education   |   August 2019
Femoral Vein Thrombus Diagnosed during Ultrasound-guided Femoral Nerve Catheter Placement
Anesthesiology 8 2019, Vol.131, 400. doi:10.1097/ALN.0000000000002754
Anesthesiology 8 2019, Vol.131, 400. doi:10.1097/ALN.0000000000002754
Deep vein thrombosis results from hemodynamic changes, endothelial dysfunction, and/or hypercoagulability, collectively termed Virchow’s triad. Patients undergoing lower-limb surgery frequently exhibit all three risk factors. Accordingly, deep vein thrombosis is common in this population. Up to 30% of patients with lower-limb orthotrauma develop preoperative deep vein thrombosis.1  Esmarch bandaging, tourniquet inflation, and/or surgical manipulation can precipitate dislodgement and pulmonary embolism, the most common cause of perioperative mortality following orthotrauma with a mortality rate of 13.8%.2 
The included still-frame ultrasound image was taken during routine preoperative placement of a femoral nerve catheter for emergent lower-limb orthopedic surgery. The occlusive right iliofemoral thrombus depicted was an important, unexpected incidental finding. The image, taken during gentle compression, and the Supplemental Digital Content (http://links.lww.com/ALN/B935), illustrate the cardinal features of deep vein thrombosis: venous noncompressibility, echogenic thrombus, venous distension, and absent color Doppler signal.3  Following formal confirmation, an inferior vena cava filter was placed prior to continuing with the planned procedure.