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The tracing of venous thromboses of the lower limbs by means of iodine 125 marked fibrinogen is possible in thoracic surgery thanks to the calibration of the apparatus on the femoral surface in cases of left thoracotomy or sternotomy. Twelve patients out of 128, i.c. 9.4%, had a positive test: 11 men and 1 woman of whom 11 had a minimum of 2 risk factors of venous thrombosis. These patients had 7 right and 5 left thoracotomies: 6 pneumonectomies (15.4% of pneumonectomies), 5 lobectomies (13% of lobectomies) and one enucleation; 11 positive tests occurred on patients operated on for cancer. There were 5 thrombo-embolic accidents: 2 fatal and 2 non fatal. Mortality was 4.28%: 6 patients of whom 3 died of infectious causes and 3 of pulmonary embolism: 2 after a pneumonectomy, respectively at 2 days and 2 months, and 1 after a lobectomy at 5 days. This examination was useful to known our percentage of isotopic thrombosis of the lower limb after thoracotomy: 9.4% which is small compared with those of the literature. However these results show the importance of instituting more prophylactic procedures to prevent venous thrombosis and thromboembolism by using heparin in all patients operated an for cancer with an exeresis and presenting 2 or more risk factors of venous thrombosis.

The incidence of deep-vein thrombosis (DVT) verified by fibrinogen test was studied in 44 high-risk patients after major non-cardiovascular thoracic surgery. In eight patients (18%) a total of ten DVT appeared within the first postoperative week. Four thrombi were located at or above knee level. More extensive surgery was associated with higher DVT incidence than lesser operations (32% v. 8%). In patients belonging to blood groups B and AB, DVT was more common than in other blood groups. Five of the six unilateral DVT were detected on the same side as the thoracotomy. The findings suggest that DVT incidence after this kind of surgery may be of the same order as after major general surgery, indicating a need for thromboprophylactic measures.

The high incidence (50-60%) of deep venous thrombosis of the legs (DVT) after major thoracic surgery is reduced only by about half with routine low-dose heparin prophylaxis. The present study compared the efficacy of a higher dose of heparin (7500 U twice daily) with the commonly used dose of 5000 U twice daily in preventing scan-detected DVT in 100 consecutive patients having thoracotomy for carcinoma of the lung or oesophagus. After the higher dose of heparin, postoperative DVT was not significantly less frequent (22% compared with 33% for total DVT) but was significantly less extensive (8% and 14%, respectively, for bilateral calf DVT, and 0% and 4% for popliteal DVT). Despite prophylaxis, DVT was especially common after oesophagogastrectomy (41% total DVT, 30% extensive DVT). No excessive postoperative bleeding was noted in either group. It is concluded that an increased dose of heparin safely offers increased prophylaxis against DVT in patients undergoing major thoracic surgery for cancer.