Postoperative incidence of deep vein thrombosis after major lower extremity amputation.

AIM: To determine the incidence of deep vein thrombosis of lower extremities up to the seven day after major lower extremity amputation in the amputated and contralateral limbs using color Doppler ultrasound. METHODS: One hundred and twenty-eight patients (67 men) underwent major lower extremity amputation (69 above-knees and 59 below-knees). All participants received unfractioned subcutaneous heparin (5000 IU TID) as prophylaxis and were evaluated using color Doppler ultrasound immediately before amputation and on the second and seventh days after amputation. The sample was composed of patients with critical limb ischemia and a primary or secondary amputation. Prophylaxis was initiated at the time of hospitalization, discontinued 12 hours before operation, and resumed 12 hours postoperatively. The primary variable was postoperative venous thrombosis. Secondary variables were: age, obesity, myocardial infarction, heart failure, immobilization and level of amputation. RESULTS: Of the 128 patients evaluated (age range: 44 to 97 years), 12 (9.4%) had venous thrombosis; in 8 (6.3%), thrombosis was ipsilateral, and in 4 (3.1%), contralateral to the amputated limb. Thrombosis was found in the thigh stump of 5 patients (3.9%); the other cases were found in the following venous segments: proximal in 2 (1.6%) patients; distal in 4 (3.1%); and proximal/distal in 1 (0.8%). CONCLUSIONS: The incidence of deep vein thrombosis of lower extremities was 9.4% in a group of patients with ischemia who underwent primary or secondary major lower extremity amputation and received prophylaxis with unfractioned heparin.

Cardiac tamponade: an unusual complication of pericardial cyst.

Pericardial cysts are not common and rarely cause symptoms. We report a unique case of a 15-year-old male patient with cardiac tamponade clinically diagnosed who was referred for echocardiography. Transthoracic echocardiography revealed, in addition to a large pericardial effusion associated with echocardiographic signs of cardiac tamponade, an 8 x 5 cm echofree image suggesting a pericardial cyst adjacent to the right atrium. Immediately after pericardiocentesis, yielding a serosanguinous liquid, the patient showed striking clinical improvement and echocardiography demonstrated minimal pericardial effusion with persistence of the cystic image. At surgery a pericardial cyst containing a sanguinous fluid was found and the pathologic findings were consistent with hematic pericardial cyst. Thus echocardiography played a fundamental role for the diagnosis and treatment of the rare complication of a pericardial cyst documented in this patient.