Clinical uses of functional ascending phlebography of the lower extremity

Deep venous thromboembolism in patients undergoing inguinal lymph node dissection for melanoma

Deep venous thromboembolism (DVT) was studied in 44 patients with clinical Stage I, II, and III melanoma undergoing staging and therapeutic inguinal lymph node dissection. The ability of two noninvasive methods of surveillance, the phleborheograph (PRG) and the 125I fibrinogen scan to detect deep venous thrombosis was determined by comparison with prospective bilateral lower extremity venograms. In addition, the therapeutic impact, both beneficial and detrimental, of low dose heparin, 5000 units administered subcutaneously two hours prior to and every eight hours after operation was determined in a double blind study. The sensitivity of the PRG and 125I fibrinogen scan were both 20%. There were five deep venous thrombi, and two pulmonary emboli for a combined incidence of DVT of 13.6% for the entire patient population. However, there was no significant difference in the incidence of DVT between the two groups. The heparin-treated patients had an increased total volume (796 +/- 516 versus 388 +/- 208 ml; p less than 0.05), and duration of wound drainage (9 +/- 4 versus 13 +/- 6 days; p less than 0.05).

[The course of postoperative deep vein thrombi as judged by repeated phlebographies]

Phlebography was carried out in a prospective randomised, controlled study during which dextran and small doses of s.c. heparin have been compared in general surgical and urological patients, in 31 persons with proven deep vein thrombois diagnosed with the 125I-fibrinogen test. In 16 out of the 31 patients a second phlebogram coule be performed two weeks later. In this study all thrombi occurred intraoperatively. In 24 of the 31 patients, the appearance of thrombi was multilocular. Independent of the prevention instituted and irrespective of the therapy, the following phenomena could be seen 14 days after the first phlebogram: 9 thrombi retracted, 6 disappeared completely and 1 occluded the vein completely. 2 thrombi disappeared without any therapy whatsoever, the 4 others disappeared in patients receiving heparin and/or coumarin for treatment.