Br. J. Surg. Vol. 64 (1977)517-518
Deep venous thrombosis in patients having aorto-i liac reconstruction N . S. A N G E L I D E S , A . N . N I C O L A I D E S , J. F E R N A N D E S , I. G O R D O N - S M I T H , R O S E M A R Y BOWERS A N D J. D . LEWIS* Results The 125Z-labelled fibrinogen test has been used to assess Eighteen (20.5 per cent) of the 88 patients studied the incidence of deep venous thrombosis in 88 patients developed deep venous thrombosis. Thrombosis was who had undergone elective aorto-iliac reconstruction. bilateral in 7 and unilateral in 11 patients. It involved Deep venous thrombosis was detected in I 8 (20.5 per the right leg only in 5 and the left leg only in 6 patients. cent). The results suggest that these patients merit In 9 limbs thrombosis occurred between days 1 and 3, prophylaxis. in 7 limbs between days 4 and 7 and in 9 limbs between days 8 and 10. The increased radioactivity THEtrue incidence of deep venous thrombosis cannot was first detected in the calf in 24 limbs and in the be estimated clinically because signs are unreliable in lower thigh in 1. Extension of radioactivity proximal diagnosing the condition (Flanc et al., 1968; Kakkar to the knee was present in 6 limbs. Venography et al., 1969; Nicolaides, 1972). The 1251-labelled confirmed the presence of deep venous thrombosis fibrinogen test has been shown to be an accurate proximal to the calf in these limbs. The relation of deep venous thrombosis to the method of detecting deep venous thrombosis (Flanc et aI., 1968; Negus et al., 1968). By this technique the operations performed is shown in Table I. Deep postoperative incidence of venous thrombosis has venous thrombosis occurred in 12 patients out of 36 been found to vary from 15 per cent in patients having who had an abdominal aortic aneurysm and in only gynaecological operations (Bonnar et al., 1972) to 6 out of 52 patients who had occlusive aorto-iliac 75 per cent in patients with pertrochanteric fractures disease. This difference is significant (Table ZZ). The (Field et al., 1972). In general surgical patients the mean age of the patients who had an abdominal incidence varied from 24 per cent (Nicolaides et al., aortic aneurysm was 60.2 f 9.4 years and that of the patients with occlusive aorto-iliac disease was 58.4 k 1972) to 35 per cent (Flanc et al., 1968). In recent years effective means of prevention have 10.6. become available (Nicolaides and Gordon-Smith, 1975). The incidence of postoperative deep venous Table I: DISTRIBUTION O F 88 PATIENTS thrombosis can be decreased by methods which ACCORDING TO TYPE O F OPERATION prevent either venous stasis (Browse and Negus, 1970; PERFORMED No. of Datients ODeration Hills et al., 1972; Nicolaides et al., 1972) or the hypercoagulable state (Gordon-Smith et al., 1972; Abdominal aortic aneurysm Kakkar et al., 1972; Nicolaides et al., 1972). Inlay tubular graft Bifurcation graft The aim of this study was to determine the incidence Occlusive aorto-iliac disease of deep venous thrombosis in patients having aortoBifurcation graft iliac reconstruction. Such information would be of Endarterectomy value in deciding whether prophylactic measures lliofemoral graft should be applied to this group of patients. SUMMARY
88 (18)
Total
Patients and methods Eighty-eight patients (69 male and 19 female) were studied. Their ages ranged from 36 to 78 with a mean of 59.8 years. All the patients were suffering from aorto-iliac disease and underwent elective aorto-iliac reconstruction. The operations performed are shown in Table I. All patients received intra-arterial heparin during the operation. This varied from 5000 to 10000 units and it was given 3 min before the application of arterial clamps. It was reversed at the end of the operation by intravenous protamine sulphate in a dose of 2 mg/100 units of heparin given. All the patients were screened by the 12s1-labelledfibrinogen test using the Pitman 235 isotope localization monitor (Kakkar et al., 1970). 1Z61-labelledfibrinogen (100 pCi) was given intravenously on the day of operation, after the thyroid gland had been blocked with sodium iodide. The patients’ legs were scanned 2 h after the injection of the 1Z51-labelledfibrinogen and then daily for 10 days. A second dose of 100 pCi was given on the fifth or sixth postoperative day. Deep venous thrombosis was considered present when a 20 per cent increase was observed in the radioactive value at the same place on two different days, or between two adjacent sites on the same day, provided that this increase persisted for more than 24 h. Venography was performed whenever the increased radioactivity involved the popliteal or more proximal sites. 43
Figures in parentheses indicate the number of patients who developed deep venous thrombosis. Table II: PATIENTS DEVELOPING DEEP VENOUS THROMBOSIS (DVT) No DVT DVT Total Abdominal aortic aneurysm Occlusive aorto-iliac disease Total
24 46 70
12 (33%) 6(12%) 18(20%)
36 52 88
xz (with Yates’ correction) = 5.07, P
Deep venous thrombosis in patients having aorto-i liac reconstruction N . S. A N G E L I D E S , A . N . N I C O L A I D E S , J. F E R N A N D E S , I. G O R D O N - S M I T H , R O S E M A R Y BOWERS A N D J. D . LEWIS* Results The 125Z-labelled fibrinogen test has been used to assess Eighteen (20.5 per cent) of the 88 patients studied the incidence of deep venous thrombosis in 88 patients developed deep venous thrombosis. Thrombosis was who had undergone elective aorto-iliac reconstruction. bilateral in 7 and unilateral in 11 patients. It involved Deep venous thrombosis was detected in I 8 (20.5 per the right leg only in 5 and the left leg only in 6 patients. cent). The results suggest that these patients merit In 9 limbs thrombosis occurred between days 1 and 3, prophylaxis. in 7 limbs between days 4 and 7 and in 9 limbs between days 8 and 10. The increased radioactivity THEtrue incidence of deep venous thrombosis cannot was first detected in the calf in 24 limbs and in the be estimated clinically because signs are unreliable in lower thigh in 1. Extension of radioactivity proximal diagnosing the condition (Flanc et al., 1968; Kakkar to the knee was present in 6 limbs. Venography et al., 1969; Nicolaides, 1972). The 1251-labelled confirmed the presence of deep venous thrombosis fibrinogen test has been shown to be an accurate proximal to the calf in these limbs. The relation of deep venous thrombosis to the method of detecting deep venous thrombosis (Flanc et aI., 1968; Negus et al., 1968). By this technique the operations performed is shown in Table I. Deep postoperative incidence of venous thrombosis has venous thrombosis occurred in 12 patients out of 36 been found to vary from 15 per cent in patients having who had an abdominal aortic aneurysm and in only gynaecological operations (Bonnar et al., 1972) to 6 out of 52 patients who had occlusive aorto-iliac 75 per cent in patients with pertrochanteric fractures disease. This difference is significant (Table ZZ). The (Field et al., 1972). In general surgical patients the mean age of the patients who had an abdominal incidence varied from 24 per cent (Nicolaides et al., aortic aneurysm was 60.2 f 9.4 years and that of the patients with occlusive aorto-iliac disease was 58.4 k 1972) to 35 per cent (Flanc et al., 1968). In recent years effective means of prevention have 10.6. become available (Nicolaides and Gordon-Smith, 1975). The incidence of postoperative deep venous Table I: DISTRIBUTION O F 88 PATIENTS thrombosis can be decreased by methods which ACCORDING TO TYPE O F OPERATION prevent either venous stasis (Browse and Negus, 1970; PERFORMED No. of Datients ODeration Hills et al., 1972; Nicolaides et al., 1972) or the hypercoagulable state (Gordon-Smith et al., 1972; Abdominal aortic aneurysm Kakkar et al., 1972; Nicolaides et al., 1972). Inlay tubular graft Bifurcation graft The aim of this study was to determine the incidence Occlusive aorto-iliac disease of deep venous thrombosis in patients having aortoBifurcation graft iliac reconstruction. Such information would be of Endarterectomy value in deciding whether prophylactic measures lliofemoral graft should be applied to this group of patients. SUMMARY
88 (18)
Total
Patients and methods Eighty-eight patients (69 male and 19 female) were studied. Their ages ranged from 36 to 78 with a mean of 59.8 years. All the patients were suffering from aorto-iliac disease and underwent elective aorto-iliac reconstruction. The operations performed are shown in Table I. All patients received intra-arterial heparin during the operation. This varied from 5000 to 10000 units and it was given 3 min before the application of arterial clamps. It was reversed at the end of the operation by intravenous protamine sulphate in a dose of 2 mg/100 units of heparin given. All the patients were screened by the 12s1-labelledfibrinogen test using the Pitman 235 isotope localization monitor (Kakkar et al., 1970). 1Z61-labelledfibrinogen (100 pCi) was given intravenously on the day of operation, after the thyroid gland had been blocked with sodium iodide. The patients’ legs were scanned 2 h after the injection of the 1Z51-labelledfibrinogen and then daily for 10 days. A second dose of 100 pCi was given on the fifth or sixth postoperative day. Deep venous thrombosis was considered present when a 20 per cent increase was observed in the radioactive value at the same place on two different days, or between two adjacent sites on the same day, provided that this increase persisted for more than 24 h. Venography was performed whenever the increased radioactivity involved the popliteal or more proximal sites. 43
Figures in parentheses indicate the number of patients who developed deep venous thrombosis. Table II: PATIENTS DEVELOPING DEEP VENOUS THROMBOSIS (DVT) No DVT DVT Total Abdominal aortic aneurysm Occlusive aorto-iliac disease Total
24 46 70
12 (33%) 6(12%) 18(20%)
36 52 88
xz (with Yates’ correction) = 5.07, P
