Venous repairs compared with ligation procedures led to no difference in the rates of deep vein thrombosis (DVT) or pulmonary embolism (PE) in patients with lower extremity venous injury, according to research in Trauma Surgery & Acute Care Open.

Patients with venous injuries are at greater risk of venous thromboembolism (VTE). The study authors sought to determine how ligation and surgery affect these risks. They hypothesized that ligation would lead to higher rates of DVT but lower rates of PE when compared to surgical repair.

The authors performed a retrospective analysis of 1,214 patients with iliac, femoral, popliteal, or tibial venous injury.

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Surgical repair was more often performed for injuries at each anatomic location. Femoral venous injury had the highest rate of DVT development at 11%, while iliac vein injuries had the highest rate of PE at 2.2%.

There was no significant difference in outcomes for all anatomic locations between treatment with repair and treatment with ligation. The odds ratio (OR) was 0.9 for developing a DVT and 0.69 for developing a PE.

The authors suggested that there may not be a difference in risk between the two treatment methods because of surveillance bias. DVT rates are lower in institutions with standardized lower extremity duplex screening. However, the authors did not know in which cases the screening was performed.

This study did not account for the role of anticoagulation therapy. Interpretation of results is limited by the study’s retrospective nature. The analysis also did not account for comorbidities or other risk factors that can influence the development of VTEs.

Based on these results, the authors suggested patients be managed for the risk of VTEs similarly regardless of treatment.


Farrell MS, Knudson MM, Stein DM. Venous ligation versus venous repair: does the procedure impact venous thromboembolism risk? Trauma Surg Acute Care Open. 2021;6(1):e000687. doi:10.1136/tsaco-2021-000687