Killewich L A, Aswad M A, Sandager G P, Lilly M P, Flinn W R
Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
Arch Surg. 1997 May;132(5):499-504. doi: 10.1001/archsurg.1997.01430290045007.
To study the incidence of postoperative deep venous thrombosis (DVT) in patients undergoing elective aortic reconstruction and to determine if aggressive DVT prophylaxis would reduce the incidence of DVT in these patients.
Randomized, prospective trial.
University hospital and Veterans Affairs hospital.
One hundred patients undergoing aortic reconstruction for aneurysmal or occlusive disease randomized to receive DVT prophylaxis (treatment group) or no prophylaxis (control group). Exclusion criteria included a history of DVT, long-term anticoagulant use, or a malignant neoplasm. During the study period, 12 patients were ineligible for follow-up. Ninety-eight patients completed the trial, including 50 patients in the treatment group and 48 patients in the control group. Two patients in the control group died postoperatively of unrelated causes.
Patients in the treatment group received DVT prophylaxis using a combination of low-dose heparin sodium therapy (5000 U every 12 hours) and calf-length intermittent mechanical compression devices. Control patients received no DVT prophylaxis.
The occurrence of acute lower extremity DVT diagnosed by interval venous duplex ultrasound scan surveillance performed on postoperative days 1, 3, and 7.
The overall incidence of proximal DVT in this study was 2%. One case of DVT occurred in the treatment group, and the other one occurred in the control group. There was no statistically significant difference (P = .99) in the incidence of DVT between the 2 groups. One patients in the control group had a nonfatal pulmonary embolus (1% of the patients overall).
The incidence of proximal DVT in patients undergoing elective aortic reconstruction is low compared with patients undergoing other major intraabdominal general surgical procedures. The use of aggressive DVT prophylaxis did not reduce the risk of postoperative proximal DVT in this study. The selective use of DVT prophylaxis in patients undergoing elective aortic surgery should be based on associated concomitant or evolving risk factors.
研究择期主动脉重建患者术后深静脉血栓形成（DVT）的发生率，并确定积极的DVT预防措施是否会降低这些患者DVT的发生率。
随机前瞻性试验。
大学医院和退伍军人事务医院。
100例因动脉瘤或闭塞性疾病接受主动脉重建的患者，随机分为接受DVT预防组（治疗组）或不接受预防组（对照组）。排除标准包括DVT病史、长期使用抗凝剂或恶性肿瘤。在研究期间，12例患者不符合随访条件。98例患者完成试验，其中治疗组50例，对照组48例。对照组2例患者术后死于无关原因。
治疗组患者采用低剂量肝素钠治疗（每12小时5000 U）和小腿长度间歇性机械压迫装置联合进行DVT预防。对照组患者不接受DVT预防。
术后第1、3和7天通过间隔静脉双功超声扫描监测诊断的急性下肢DVT的发生情况。
本研究中近端DVT的总体发生率为2%。治疗组发生1例DVT，对照组发生1例。两组之间DVT的发生率无统计学显著差异（P = 0.99）。对照组1例患者发生非致命性肺栓塞（占患者总数的1%）。
与接受其他主要腹部普通外科手术的患者相比，择期主动脉重建患者近端DVT的发生率较低。在本研究中，积极的DVT预防措施并未降低术后近端DVT的风险。择期主动脉手术患者DVT预防措施的选择性使用应基于相关的伴随或演变的危险因素。
