Non-invasive Surveillance of Leg Deep Vein Thrombosis ( DVT ) in Early Postopertive Period

ABSTRACT

Deep vein thrombosis is recognized as a common complication in surgical patients in western countries especially in patients with high risk factors. The purposes of this study were to detect leg DVTs in early postoperative period by non-invasive surveillance and to analyze the risk factors of DVT. One hundred seventy one patients who underwent major operations ( 67 curative resection of colorectal cancer, 64 total hip replacement, 38 femur operations for fracture, and 2 colon resections for benign colon disease) were included for the prospective surveillance of leg DVT within 2 weeks after the operations. For the surveillance of leg DVT, strain gauge plethysmography(SPG) and Duplex scanning of both legs were completed for all patients except 10 patients. These 10 patients were examined in only one leg. The patients with past history of leg DVT or under prophylactic anticoagulant therapy were excluded from this study. To determine the risk factors related with leg DVT formation, age and sex of the patients, indication of surgery or surgical procedures, duration of operation, position during the operation, duration of postoperative immobilization, and preoperative serum level of antithrombin III(AT-III) were analyzed using Chi-square test. After performing SPG of 342 legs, 38 legs showed abnormal on venous outflow/venous capacitance discriminant line chart, and 13 legs of 12 patients showed the finding(s) suggesting DVT on duplex scanning. Among the patients with abnormal duplex findings, 7 limbs(53.8%) were symptomatic, but the remaining 6 legs were silent. In 6(15.8%) patients of 36 femur operations, 3(4.7%) of 64 total hip replacements and 3(4.5%) of 67 curative resections of colorectal cancer developed DVT by duplex scanning in the iliac(5), femoral-popliteal(6), and isolated calf(2) veins. After analyzing the risk factors, we could not find any statistically significant(p<0.05) factor related with leg DVT.