Postoperative incidence of deep vein thrombosis after major lower extremity amputation.

Vieira Bandeira FC, Brandão Pitta GB, Araújo Castro A, Miranda FJ. Lauro Wanderley University Hospital, Universidade Federal da Paraíba (UFPB), João Pessoa, Brazil fmiranda@apm.org.br .

AIM: To determine the incidence of deep vein thrombosis of lower extremities up to the seventh day after major lower extremity amputation in the amputated and contralateral limbs using color Doppler ultrasound.

METHODS: One hundred and twenty-eight patients (67 men) underwent major lower extremity amputation (69 above-knees and 59 below-knees). All participants received unfractioned subcutaneous heparin (5000 IU TID) as prophylaxis and were evaluated using color Doppler ultrasound immediately before amputation and on the second and seventh days after amputation. The sample was composed of patients with critical limb ischemia and a primary or secondary amputation. Prophylaxis was initiated at the time of hospitalization, discontinued 12 hours before operation, and resumed 12 hours postoperatively. The primary variable was postoperative venous thrombosis. Secondary variables were: age, obesity, myocardial infarction, heart failure, immobilization and level of amputation.

RESULTS: Of the 128 patients evaluated (age range: 44 to 97 years), 12 (9.4%) had venous thrombosis; in 8 (6.3%), thrombosis was ipsilateral, and in 4 (3.1%), contralateral to the amputated limb. Thrombosis was found in the thigh stump of 5 patients (3.9%); the other cases were found in the following venous segments: proximal in 2 (1.6%) patients; distal in 4 (3.1%); and proximal/distal in 1 (0.8%).

CONCLUSIONS: The incidence of deep vein thrombosis of lower extremities was 9.4% in a group of patients with ischemia who underwent primary or secondary major lower extremity amputation and received prophylaxis with unfractioned heparin.

Int Angiol. 2008 Dec;27(6):489-493.