Post-Operative Leg Swelling

Written by – Dr Ashly Liu

Post-operative Leg Swelling Shownotes

DVT

Deep vein thrombosis is a venous thromboembolism found in the deep veins of the body, typically in the lower extremities. They are associated with life-threatening complications such as pulmonary embolism. In NSW hospitals, there has been a movement towards reducing the incidence of hospital-related VTE with the VTE prophylaxis assessment tool

Superficial vein thrombosis is generally benign and a self-limiting disorder. However, if axial veins are involved, there is a potential to propagate into the deep vein system as well.

Risk factors

Anatomy

Deep veins of the lower extremity

Superficial veins of the lower extremity

Management

Management depends on the patient’s risk of bleeding and the location of the DVT. Typically patients are definitively treated with therapeutic anticoagulation, thrombolytic therapy or an IVC filter.

Anticoagulation is the definitive therapy for the proximal and distal DVTs in patients whose bleeding risk is acceptable. Typically, treatment duration is for 3-6 months following commencement of anticoagulation. This is dependent on Haematology advice for consideration of follow-up and assessment of whether this incident is provoked or unprovoked, which would require further thrombophilia workup.

However, in patients with a high risk of bleeding and a lower risk of embolisation, serial surveillance of compressive ultrasounds may be considered acceptable. If there is a high risk of embolisation in patients with contraindications to anticoagulant therapy, an IVC filter would be considered.

Anticoagulation Options

References

UpToDate “Overview of the treatment of proximal and distal lower extremity deep vein thrombosis (DVT)”

UpToDate “Direct oral anticoagulants (DOACs) and parenteral direct-acting anticoagulants: Dosing and adverse effects”