Peri-operative venous thrombosis and pulmonary embolism

Despite many significant advances in surgery and anaesthesia, the incidence of deep venous thrombosis and pulmonary embolism remains unacceptably high. The occurrence and degree of risk are related to a number of factors, involving both the patient and the surgical procedure. These include the type and site of surgery, particularly if it includes the pelvis and/or lower limb and whether direct trauma or malignant disease is involved. Other patient-related factors including coincidental drug therapy are discussed, together with detailed consideration of the presenting features and the methods of preventing venous thromboembolism, both mechanically and pharmacologically. The treatment of deep venous thrombosis and pulmonary embolism either locally or systemically is evaluated. Consideration is also given to appropriate identification of the risk to individual patients by routine accurate pre-operative assessment, allowing appropriate prophylactic measures to be instituted.