Prospective screening for postoperative deep venous thrombosis in patientsundergoing infrainguinal revascularization

Purpose: The incidence of deep venous thrombosis (DVT) in patients undergoi ng infrainguinal bypass graft procedures has not been well documented, and the need for routine prophylaxis remains controversial. The purpose of this study was to prospectively evaluate the risk of postoperative DVT complica ting infrainguinal revascularization. Methods: Seventy-four patients undergoing infrainguinal bypass graft proced ures during a 12-month period were prospectively screened for DVT. Bilatera l lower extremity venous duplex scan imaging was performed preoperatively a nd within 1 week and 6 weeks, postoperatively. Routine DVT prophylaxis was not used, with anticoagulation reserved for specific indications. Results: Of the 74 patients screened, three patients (4.1%) had DVT identif ied on preoperative venous duplex scan imaging and were excluded from the s tudy. Of the remaining 71 patients enrolled, only two patients (2.8%) had p ostoperative DVT. Postoperative DVT was ipsilateral to the bypass graft ext remity in both patients, with involvement of the peroneal vein in one patie nt and the femoral vein in the other. Although routine prophylaxis was not used, 18 of these patients (25%) were anticoagulated for other indications, with DVT occurring in one patient (5.6%). Of the remaining 53 patients who did not receive postoperative anticoagulation, only one patient (1.8%) had DVT. Conclusions: According to this prospective study, the risk of postoperative DVT in patients undergoing infrainguinal revascularization is low Routine prophylaxis is not recommended, with postoperative anticoagulation reserved for specific indications.