The Incidence of Deep Venous Thrombosis in Patients with Leg Oedema After Arterial Reconstruction

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Abstract
Twenty-five patients, who developed oedema of the operated leg after successful arterial reconstruction, were examined by phlebography in order to determine the incidence of postoperative deep venous thrombosis. Only two patients (8%) had phlebographic evidence of venous thrombosis, and then only in the calf veins of the operated leg. Four factors are considered as being contributory to the low incidence of venous thrombosis after the arterial reconstructions in the present study. (1) Post reconstructive hyperaemia with resulting increase of venous blood flow in the extremity. (2) Anticoagulation therapy with moderate doses of heparin, primarily directed at the prevention of arterial thrombosis during the operation. (3) Dextran administration, primarily administered to improve the peripheral arterial blood flow. (4) Destruction of lymph channels at the sites of dissection with compensatory increase of venous back-flow in the operated extremity. Arterial reconstructions of the lower extremity are frequently followed by oedema of the foot and leg, which may last for weeks or months and may worry both the patient and the surgeon (Fig. 1). Three causes have been suggested for this oedema: deep venous thrombosis (Taylor, 1962), disturbance of lymph drainage (Vaughan et al., 1970) and increased filtration from capillaries, which are suddenly exposed to normal blood pressure after having been adapted to low pressure for a prolonged time, with resulting degeneration of the arterial wall (Simeone & Husni, 1959; Husni & Manion, 1967). Undoubtedly each of these factors may cause oedema and, furthermore, two or more factors may be present at the same time, but may be difficult to distinguish by clinical methods. This study was made to determine by an objective method, phlebography, the incidence of deep venous thrombosis in patients who developed leg oedema after arterial reconstructions for obstructive atherosclerosis.