Prevalence of lower limb deep venous thrombosis using doppler ultrasound among patients with abdomino-pelvic malignancies at the Uganda Cancer Institute.

Abstract

Introduction: Venous thromboembolism (VTE), a term encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major complication of cancer. Studies show that 10-15% of patients with cancer suffer a VTE episode. The risk of thromboembolic disease in cancer patients is further increased by surgery ,immobility and chemotherapy. In the USA, VTE incidence is approximated at 10% among patients with various abdomino-pelvic cancers. In Uganda, informal observation had shown a high trend among patients with abdomino-pelvic malignancies. Objective: Therefore, this study set out to determine the prevalence of lower limb deep venous thrombosis using Doppler ultrasound among patients with abdomino- pelvic cancers at the Uganda Cancer Institute (UCI). Methods: This was a descriptive cross sectional study in which eligible patients were recruited from the Uganda Cancer Institute and Doppler Ultrasound done in the Radiology department of Mulago Hospital. A sample of 200 consenting adult patients diagnosed with abdomino-pelvic malignancies underwent Doppler ultrasound of both lower limb deep veins.

Results: Of the 200 patients scanned, 90 were found to have DVT which corresponded to a prevalence of 45%. The prevalence of latent DVT among patients with abdomino-pelvic cancers was 8%. The presence of DVT was 14 times more likely in patients with cancer of the cervix (p=0.000), 3 times more likely with colorectal cancer (p=0.033) and 3 times more likely with cancer of the endometrium (p=0.029). Most of the veins among patients with latent DVT, were either completely or partially compressible in either leg while most of the veins among the patients with symptomatic DVT were non compressible. The spontaneous color Doppler signal was either low or absent among patients with latent DVT. Conclusion: Patients with cancer of the cervix, endometrium and colon are at an increased risk for the development of lower limb DVT. This study recommends that any patient diagnosed with an abdomino-pelvic cancer should have routine screening for lower limb DVT using Doppler ultrasound regardless of whether they have sings for DVT or not. Further studies should be done to ascertain when and how often the routine Doppler ultrasound scans should be done among these patients.