DEEP-VEIN THROMBOSIS ASSOCIATED WITH LOWER-EXTREMITY AMPUTATION

Purpose: Patients undergoing lower extremity amputation are perceived to be at high risk for deep vein thrombosis (DVT). Limited data are av ailable, however, to confirm this impression. The purpose of this stud y is to prospectively document the incidence of DVT complicating lower extremity amputation. Methods: During a recent 28-month period, 72 pa tients (71 men, 1 woman; mean age 68 years) undergoing major lower ext remity amputation (31 above-knee and 41 below-knee) were prospectively evaluated with perioperative duplex scanning for DVT. Results: DVT wa s documented in nine (12.5%) patients (one bilateral, four ipsilateral , and four contralateral to amputation). Patients with a history of ve nous disease were at significantly higher risk for development of DVT (p = 0.02). Thrombi were located at or proximal to the popliteal vein in eight patients and were isolated to the tibial veins in one patient ; DVT was identified before operation in six patients and after operat ion in three. Patients with DVT were treated with heparin anticoagulat ion, with no patient experiencing clinical symptoms compatible with pu lmonary embolism. Conclusions: In our recent experience, lower extremi ty amputation is associated with DVT at or proximal to the popliteal v ein in 11% of patients. Documentation of DVT prevalence is essential t o assist surgeons in planning a management strategy for prevention, di agnosis, and treatment of DVT associated with lower extremity amputati on.