الفهرس 
ANATOMY OF LOWER LIMB VENOUS SYSTEMOnly 14 pages are availabe for public view
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Abstract
ower extremity amputation ranging from toe amputation to hip disarticulation offers an assortment of treatment options for a multitude of diseases including limb ischemia, infection and major trauma. Above-knee amputation and below-knee amputation are frequently performed and dramatically impact a patient’s life.
Understanding key principles allows for better prediction of the correct level of amputation for the patient while maintaining the maximal functionality that can be offered. Many opportunities exist to more accurately predict and allow for improved wound healing and functionality. Following lower extremity amputation, the risk of DVT is up to50%.
The aim of this study is to prospectively document the incidence of DVT complicating major lower extremity amputation (above and below knee amputation) in patients using prophylactic anticoagulants.
The prospective study involved 35 patients underwent unilateral lower limb amputation. The mean age was 45 ± 8.8 years (range: 18 to 55 years). They were 19 males (54.29%), and 16 females (45.71%), with ratio of 1.2: 1.
Patients received prophylactic anticoagulant (Apixaban 2.5mg twice daily) immediately postoperatively and for 6 weeks, assessment after 3 & 6 weeks was done using duplex to exclude presence of DVT.
Regarding smoking, most of patients were smokers, 20 patients (57.1%). The BMI mean was 28.4 ± 2.6, with median of 28, ranged from 26 to 35.
As regard to comorbidities of the studied patients, we noticed that diabetes was the most common disease among those patients. Despite that, there was no statistically significant difference between comorbidities and incidence of DVT.
As regard to causes of amputation, trauma with MESS score more than 7 was associated with 2 cases of BKA and 2 cases AKA, with no statistically significant difference between both groups.
Infection was associated with higher incidence of BKA in 12/20 patients (60%), while 3/15 patients (20%) subjected to AKA, with statistically significant difference, (HR=0.1 (95%CI: 0.03,0.7); (p=0.02).
Infection was associated with higher incidence of patients who developed post-operative DVT, as 11/15 patients (73.3%) had history of infection caused amputation, developed DVT (p = 0.002).
As regard to ulceration, it was responsible for 6 cases of BKA and 4 cases of AKA, with no statistically significant difference between both groups. But gangrene was associated with 6/15 patients (40%) who were subjected to AKA, with statistically significant difference (HR=0.1 [95%CI: 3.5-7.2]; p=0.002).
On the other hand, there was no statistically significant difference between incidence of DVT and site of amputation, as 5/15 patients (33.3%) who underwent to BKA developed DVT, while 10/20 patients (50%) who underwent to AKA, developed DVT [HR:1.6 (95%CI:0.4-6.5), p=0.487].
As regard to diseased venous segment, femoral vein thrombosis was associated with AKA, while popliteal vein thrombosis was associated with BKA.
Assessment of DVT presence after amputation was the primary endpoint for this prospective study, using venous duplex after 3 weeks from surgery, revealed that 9/15 patients (60%) who underwent AKA developed DVT, while 2/20 patients (10%) who underwent BKA developed DVT (p = 0.001).
Assessment after 6 weeks revealed that 3/20 patients (15%) who underwent BKA developed DVT, while 1/15 patient (6%) who underwent AKA developed DVT (p=0.6), with no statistically significant difference, thus emphasize that AKA was associated with early higher incidence of DVT rather than BKA.
CONCLUSION AND RECOMMENDATIONS
D
VT is a common complication following major lower limb amputation. And preoperative infection is considered main risk factor and increase risk of DVT.
Occurrence of DVT is more in patients with AKA than others with BKA.
Using prophylactic anticoagulants decrease risk of DVT up to 50%.
And using of DOACs shows non-significant difference from other types of anticoagulants regarding incidence of DVT following major lower limbs amputation.