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 (https://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.

Ultrasound-guided regional techniques provide a unique chance for opportunistic point-of-care ultrasound targeting deep vein thrombosis. The finite, readily assessable features of deep vein thrombosis are amenable to point-of-care ultrasound. Anesthetists have the skillset and opportunity for point-of-care ultrasound targeting deep vein thrombosis. Anesthetists are familiar with ultrasound imaging, expert in neurovascular anatomy, care for the relevant population, and inevitably image common sites of deep vein thrombosis during lower-limb regional procedures. We present this image to remind clinicians that deep vein thrombosis is common, outline the cardinal sonographic features of deep vein thrombosis, and illustrate the novel opportunity that ultrasound-guided regional techniques present for anesthetists to enhance patient outcomes.

The authors declare no competing interests.

1.
Wang
H
,
Kandemir
U
,
Liu
P
,
Zhang
H
,
Wang
PF
,
Zhang
BF
,
Shang
K
,
Fu
YH
,
Ke
C
,
Zhuang
Y
,
Wei
X
,
Li
Z
,
Zhang
K
:
Perioperative incidence and locations of deep vein thrombosis following specific isolated lower extremity fractures.
Injury
2018
;
49
(
7
):
1353
7
2.
Ho
KM
,
Burrell
M
,
Rao
S
,
Baker
R
:
Incidence and risk factors for fatal pulmonary embolism after major trauma: A nested cohort study.
Br J Anaesth
2010
;
105
:
596
602
3.
Tapson
VF
,
Carroll
BA
,
Davidson
BL
,
Elliott
CG
,
Fedullo
PF
,
Hales
CA
,
Hull
RD
,
Hyers
TM
,
Leeper
KV
Jr
,
Morris
TA
,
Moser
KM
,
Raskob
GE
,
Shure
D
,
Sostman
HD
,
Taylor Thompson
B
:
The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society.
Am J Respir Crit Care Med
1999
;
160
:
1043
66