Pulmonary embolism associated with surgically proved deep venous thrombosis

In a prospective study, thrombosis of the femoral or popoliteal veins was discovered at operation in nine of eighty-one patients requiring amputation of a lower extremity for arterial insufficiency. One week postoperatively, all nine patients had evidence of pulmonary embolism on the lung scan. Embolization was documented by arteriography in two patients and at autopsy in a third patient. In none of these patients was there clinical evidence of venous thrombosis prior to operation. Two of the subjects with proved thrombosis died during study, a mortality of 22 percent, whereas the mortality for the entire group was 10 percent. It is concluded that the deep venous system of patients requiring amputation for ischemia should be examined carefully at operation. These patients have a high incidence of deep venous thrombosis and the discovery of thrombus at the time of operation places them in a particularly high risk group.