open access

Vol 12, No 2 (2010)
Published online: 2011-02-04
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Lower extremity deep vein thrombosis in patients with chronic leg isaemia after femoro-popliteal bypass

Tomasz Urbanek, Marcin Kucharzewski, Damian Ziaja, Grzegorz Biolik, Krzysztof Kubicki, Malwina Rybicka
Chirurgia Polska 2010;12(2):76-84.

open access

Vol 12, No 2 (2010)
Published online: 2011-02-04

Abstract


Introduction: According to daily practice, as well as some reports in the literature, vascular complications can also concern the venous system in patients undergoing vascular reconstruction of the lower extremity arterial system. In the absence of antithrombotic prophylaxis, DVT can be expected in 15–25% of “major” vascular surgery patients. The aim of the study was to determine the risk of DVT occurrence after femoro-popliteal bypass implantation in patients with chronic leg ischaemia.
Material and methods: The study was performed on a group of 50 patients with intermittent claudication and chronic leg ischemia, aged from 48 to 82 years old and qualified for dacron graft implantation in the femoro-popliteal segment. All the patients were assessed clinically while the deep vein system of the lower extremity was assessed by the means of the Doppler US preoperatively, as well as on the 1st, 4–5th an 30th day after surgery. Preoperatively, all the patients underwent the VTE risk factor assessment. In all the cases, anticoagulant treatment followed by antiplatelet agents was administered perioperatively.
Results: Among 50 patients examined up until the 30th postoperative day, there were no clinicallysymptomatic cases of DVT of the operated extremity recognized. Asymptomatic DVT was found in 4 cases (8%) of those operated upon and in 1 case (2%) of the contralateral leg (within a 30 day follow-up). In the period until hospital discharge, DVT was diagnosed in only 2 patients (4%), other 3 cases (6%) occurred during the follow-up to 30 days after surgery.
Conclusions: Despite the use of perioperative heparin/low molecular weight heparin (also in therapeutic doses), revascularization in the femoral-popliteal segment by means of a surgical bypass is not free from thrombotic events in the deep venous system. The lack of obvious clinical signs, as well as an asymptomatic course of the disease often occurring, emphasize the need of control imaging studies (Doppler US) in any case of clinical suspicion. Due to the risk of thromboembolic complications, each patient qualified for vascular reconstruction of the arterial system should be evaluated in terms of indications for the implementation of VTE prophylaxis. Due to the occurrence of complications in VTE events, which also may occur during the period after being discharged from hospital, the final definition of an adequate duration of the prophylaxis requires further studies.

Polish Surgery 2010, 12, 2, 76–84

Abstract


Introduction: According to daily practice, as well as some reports in the literature, vascular complications can also concern the venous system in patients undergoing vascular reconstruction of the lower extremity arterial system. In the absence of antithrombotic prophylaxis, DVT can be expected in 15–25% of “major” vascular surgery patients. The aim of the study was to determine the risk of DVT occurrence after femoro-popliteal bypass implantation in patients with chronic leg ischaemia.
Material and methods: The study was performed on a group of 50 patients with intermittent claudication and chronic leg ischemia, aged from 48 to 82 years old and qualified for dacron graft implantation in the femoro-popliteal segment. All the patients were assessed clinically while the deep vein system of the lower extremity was assessed by the means of the Doppler US preoperatively, as well as on the 1st, 4–5th an 30th day after surgery. Preoperatively, all the patients underwent the VTE risk factor assessment. In all the cases, anticoagulant treatment followed by antiplatelet agents was administered perioperatively.
Results: Among 50 patients examined up until the 30th postoperative day, there were no clinicallysymptomatic cases of DVT of the operated extremity recognized. Asymptomatic DVT was found in 4 cases (8%) of those operated upon and in 1 case (2%) of the contralateral leg (within a 30 day follow-up). In the period until hospital discharge, DVT was diagnosed in only 2 patients (4%), other 3 cases (6%) occurred during the follow-up to 30 days after surgery.
Conclusions: Despite the use of perioperative heparin/low molecular weight heparin (also in therapeutic doses), revascularization in the femoral-popliteal segment by means of a surgical bypass is not free from thrombotic events in the deep venous system. The lack of obvious clinical signs, as well as an asymptomatic course of the disease often occurring, emphasize the need of control imaging studies (Doppler US) in any case of clinical suspicion. Due to the risk of thromboembolic complications, each patient qualified for vascular reconstruction of the arterial system should be evaluated in terms of indications for the implementation of VTE prophylaxis. Due to the occurrence of complications in VTE events, which also may occur during the period after being discharged from hospital, the final definition of an adequate duration of the prophylaxis requires further studies.

Polish Surgery 2010, 12, 2, 76–84

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Keywords

vascular surgery; femoro-popliteal bypass; chronic leg ischaemia; deep vein thrombosis

About this article
Title

Lower extremity deep vein thrombosis in patients with chronic leg isaemia after femoro-popliteal bypass

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 12, No 2 (2010)

Pages

76-84

Published online

2011-02-04

Bibliographic record

Chirurgia Polska 2010;12(2):76-84.

Keywords

vascular surgery
femoro-popliteal bypass
chronic leg ischaemia
deep vein thrombosis

Authors

Tomasz Urbanek
Marcin Kucharzewski
Damian Ziaja
Grzegorz Biolik
Krzysztof Kubicki
Malwina Rybicka

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