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Lois A. Killewich, MD, PhD; Margo A. Aswad, MD; Gail P. Sandager, RN, RVT; Michael P. Lilly, MD; William R. Flinn, MD

Arch Surg. 1997;132(5):499-504.

Abstract
Objectives
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.

Design
Randomized, prospective trial.

Setting
University hospital and Veterans Affairs hospital.

Patients
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.

Intervention
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.

Main Outcome Measures
The occurrence of acute lower extremity DVT diagnosed by interval venous duplex ultrasound scan surveillance performed on postoperative days 1, 3, and 7.

Results
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 patient in the control group had a nonfatal pulmonary embolus (1% of the patients overall).

Conclusions
The incidence of proximal DVT in patients undergoing elective aortic reconstruction is low compared with patients undergoing other major intra-abdominal 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.

Arch Surg. 1997;132:499-504

Author Affiliations
From the Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine, Veterans Affairs Medical Center, Baltimore.

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