How Amputation Increases the Risk of Pulmonary Embolism

Amputation, particularly lower limb amputation, can raise the risk of pulmonary embolism (PE). While amputation itself doesn’t directly cause PE, some associated factors significantly increase the risk. Healthcare providers must implement preventive measures to mitigate these risks and ensure the safety and well-being of patients undergoing amputation.

What is pulmonary embolism?

Pulmonary embolism (PE) is a serious medical condition involving the sudden blockage of one or more arteries in the lungs. This blockage is typically due to a blood clot that travels from another part of the body, most commonly from the deep veins of the legs (deep vein thrombosis or DVT).

Most pulmonary embolisms occur when a blood clot, usually originating in the legs, breaks loose and travels through the bloodstream to the lungs. Clots can also form in other parts of the body (the pelvis or arms) and travel to the lungs, though this is less common. Some symptoms of PE include:

• Sudden onset: PE often presents suddenly and can be life-threatening.
• Chest pain: Sharp, stabbing chest pain that may worsen with deep breathing or coughing.
• Shortness of breath: Rapid breathing, shortness of breath, and in severe cases, cyanosis (blue discoloration of the lips and skin).
• Cough: Dry cough or coughing up blood (hemoptysis).

Rapid heart rate, lightheadedness, fainting, and symptoms suggestive of DVT (swelling, pain, warmth in the affected leg) can also be symptoms of PE.

Why does amputation increase the risk of PE?

The increased risk of PE after amputation is primarily due to several critical factors. These include:

Surgery  

Surgical procedures cause tissue damage, which triggers the body’s inflammatory response, including the activation of the coagulation system. This increases the risk of blood clot formation (thrombosis). Surgery can directly injure blood vessels, promoting clot formation at the site of injury. The surgical procedure can also alter normal blood flow, leading to areas of stasis where blood can pool and clot.

Immobilization

Prolonged immobility, especially after surgery, reduces muscle contractions in the legs. These muscle contractions are essential for helping blood flow back to the heart. Reduced muscle activity leads to slower blood flow (venous stasis), which can promote clot formation. These clots can travel to the lungs and cause a PE. Immobilization can also lead to decreased blood flow in the veins of the legs, increasing the likelihood of clot development in the deep veins (deep vein thrombosis or DVT).

Hypercoagulability

Surgery and trauma can activate the body’s clotting mechanisms, making blood more prone to clotting. This is a natural response to injury but can increase the risk of forming harmful clots. The body’s stress response to surgery can also lead to changes in blood properties, making it more likely to clot. Reduced mobility, particularly after surgery or during prolonged immobilization, can lead to blood pooling in the veins. This pooled blood is more likely to clot, leading to DVT. Once a clot forms in the deep veins, it can grow larger, increasing the risk of the clot breaking off and traveling through the bloodstream to the lungs. These clots can become lodged in the pulmonary arteries, blocking blood flow and causing a pulmonary embolism.

Inflammatory response

The body’s inflammatory response to surgery and injury can also lead to an increased risk of clotting. Surgery triggers the release of various substances that not only promote inflammation but also activate coagulation. Surgical trauma can directly damage the endothelial lining of blood vessels. This damage exposes collagen and other pro-coagulant substances, promoting clot formation. The inflammatory response can impair the production of natural anticoagulants such as protein C and protein S, further encouraging the formation of clots.

How can the risk of PE after amputation be lessened?

To mitigate the risk of PE after amputation, medical professionals often implement various strategies, including:

• Anticoagulant therapy: Administering medications like heparin can help prevent clot formation.
• Mechanical prophylaxis: Using compression stockings or pneumatic compression devices improve blood flow and reduce stasis.
• Early mobilization: Encouraging patients to move and ambulate as soon as possible after surgery can help prevent venous stasis.
• Monitoring: Patients should be regularly assessed and monitored for signs and symptoms of DVT and PE after amputation.

By understanding the relationship between surgery, inflammation, and clotting mechanisms, healthcare providers can better manage and reduce the risk of pulmonary embolism in surgical patients.

Can PE ever be the result of medical malpractice?

Pulmonary embolism (PE) can potentially result from medical malpractice under certain circumstances. These might include:

• Failure to recognize risk factors: Healthcare providers have a duty to assess a patient’s risk factors—prior history of clotting disorders, recent surgery, prolonged immobilization—for pulmonary embolism. Failure to recognize and address these risk factors could lead to a missed opportunity for preventive measures.
• Failure to provide prophylaxis: Patients at high risk of pulmonary embolism, such as those undergoing major surgery or with predisposing medical conditions, should receive anticoagulant medications, mechanical devices (like compression stockings), and early mobilization protocols. If preventive measures are not implemented, it could contribute to the development of PE.
• Errors in diagnosis and treatment: Timely and accurate diagnosis of pulmonary embolism is critical for initiating prompt treatment. Errors in interpreting diagnostic tests such as misreading imaging studies like CT scans, failure to consider pulmonary embolism in the diagnosis, or delays in starting treatment can worsen the condition and lead to adverse outcomes.
• Inadequate monitoring and follow-up: After surgery or during hospitalization, patients should be monitored for signs and symptoms of pulmonary embolism. Failure to monitor or recognize worsening symptoms could delay intervention and lead to unfavorable outcomes.
• Surgical errors: In some cases, surgical procedures themselves may contribute to the formation of clots or embolism, especially if proper precautions to prevent clotting during surgery are not taken.

The attorneys at McGowan, Hood, Felder & Phillips, LLC know what it takes to build a successful medical malpractice case. Our South Carolina law firm has obtained significant settlements and recoveries on behalf of people who were injured due to medical negligence. To schedule your free case evaluation, call or fill out our contact form today. We want to help.