808 - An Unprovoked DVT in an Amputee in the Post Acute Rehab Setting: A Case Report

Deep vein thrombosis

Case Description:

A 69-year-old male who underwent right BKA in 2019 presented to the emergency department in December 2023 with right lower extremity swelling, redness, and tightness. He had been using a suction suspension with outer sleeve and flexible inner socket prosthesis. Duplex ultrasound revealed a DVT extending from the right iliac vein to the right common femoral vein.  Thrombosis was consulted and recommended anticoagulation for 3 months using a DOAC. He was evaluated two weeks after initiating anticoagulation in the amputee clinic with mildly improved swelling; he remained unable to tolerate his prosthesis for extended periods of time. He completed his anticoagulation course in March and noted overall modest improvement. We recommended a gel sleeve with more elastic properties to accommodate changes in size or shape and a thrombosis referral to evaluate for potential extended anticoagulation. Thrombosis classified his DVT as unprovoked and recommended lifelong anticoagulation. His swelling improved by May.
 

Discussions:

There are several studies documenting the incidence and risk of DVT in amputees in the early postoperative phase and the acute rehabilitation phase. However, there are limited reports of DVTs occurring in amputees in the stable, post acute rehab setting. An extensive literature review identified two such cases, and both had predisposing factors increasing the risk for DVT formation including BKA within 3 months of presentation and recent abscess excision surgery.

Conclusions:

To our knowledge, this is the first instance of an unprovoked DVT in a residual limb in the stable, post acute rehab setting. This case further emphasizes the importance of considering DVT when amputees present with swelling and pain in their residual limb, even without identified provoking factors. The most appropriate length of treatment remains a source of debate.