[A case of deep vein thrombosis in spite of using an intermittent pneumatic compression device].

A 69-year-old male patient underwent subtotal esophagectomy for esophageal cancer under sevoflurane anesthesia combined with epidural analgesia. According to the protocol for the prevention of deep vein thrombosis (DVT) in our hospital, only an intermittent pneumatic compression device (IPC) and elastic stockings were perioperatively used for prophylaxis of DVT although D-dimer level was slightly increased to 1.2 microg x ml(-1). On the 2nd post-operative day, a venous ultrasound examination was performed, because D-dimer level was suddenly increased up to 41.5 microg x ml(-1) without any signs of thrombus in the atrium and pleural cavity. Since DVT was detected with the right lower limb, the use of an IPC was stopped and an inferior vena cava filter was inserted through the right jugular vein with a continuous administration of heparin. An aggressive search should be performed if DVT is suspected by any clinical signs including an increase in D-dimer level. We should also keep in mind the possibility of DVT even if an IPC and elastic stockings are perioperatively used.