Superficial Thrombophlebitis

Superficial venous thrombophlebitis (SVT) is a relatively common problem that may yield under-appreciated complications of venous thromboembolism including deep venous thrombosis (DVT) and pulmonary embolism (PE) . Duplex ultrasonography remains the diagnostic gold standard. Treatment considers the extent and location of thrombus burden. Mild forms of SVT may be treated with conservative measures that include nonsteroidal anti-inflammatory drugs (NSAIDs) , elastic compression, and elevation. Anti-coagulation with 2.5 mg fondaparinux favored over prophylactic low-molecular-weight heparin is indicated for moderate thrombus burden, defined as thrombus that measures at least 5 cm in length located at least 3 cm distal to the saphenofemoral junction. Surgical interventions remain indicated for select patients with moderate thrombus burden that cannot tolerate anti-coagulation [i.e., great saphenous vein (GSV) disconnection and ligation] and those with documented venous insufficiency and associated varicose veins (i.e., GSV ablation and phlebectomy). Finally, therapeutic anti-coagulation remains applicable to patients that develop associated DVT or PE.

Duke Scholars

Author Dawn M Coleman Surgery, Vascular and Endovascular Surgery