Oberflächliche Venenthrombose der Beinvenen – Eine systematische Übersicht – Teil 1: Definition, Ätiologie, Diagnostik

Zusammenfassung

Einleitung Die oberflächliche Venenthrombose (OVT) der Beinvenen ist mit einer Inzidenz von 0,5–1/1000 Einwohner/Jahr ein häufiges und mit einer Frequenz assoziierter thromboembolischer Ereignisse in bis zu 25 % der Fälle ein ernst zu nehmendes Krankheitsbild. In der vorliegenden Übersichtsarbeit sollen alle relevanten Aspekte der OVT basierend auf der aktuellen wissenschaftlichen Literatur behandelt werden.

Methoden Die systematische Übersicht umfasst das Wissen über die OVT basierend auf dem gesamten, systemisch recherchierten Erkenntnismaterial in den Datenbanken PubMed und Google Scholar. Eine Literaturrecherche in PubMed von Publikationen (1968–2018) mit den Suchbegriffen „Superficial vein thrombosis; thrombophlebitis“ ergab 102 aussagekräftige Arbeiten, die nach Vorlage der Originalarbeit ausgewertet wurden. Teil 1 der Arbeit behandelt Aspekte zur Definition, Klassifikation, Ätiologie und Diagnostik.

Ergebnisse Die OVT manifestiert sich klinisch neben den typischen Entzündungszeichen als strangförmige Induration, die Ausdruck eines thrombotischen Verschlusses epifaszialer Venen ist. Ätiologisch bedeutsam ist das Vorhandensein von Varikose (68 % der Fälle), Adipositas (23 %), Gerinnungsstörungen (18 %) und Tumorleiden (8 %). Das Durchschnittsalter der Betroffenen beträgt 62 Jahre, in 60 % der Fälle sind Frauen betroffen. Zunehmendes Lebensalter ist ein relevanter Risikofaktor. Diagnostisch ist es wichtig, das genaue Ausmaß der OVT zu beschreiben, insbesondere die Thrombuslänge und die Entfernung zum tiefen Venensystem. Dies, einschließlich der Beurteilung des tiefen Beinvenensystems, sollte bei jedem Patienten mit möglicher OVT zeitnah mittels Ultraschalldiagnostik erfolgen. Eine hier vorgeschlagene Klassifikation von 4 Ausprägungsgraden der OVT kann die Zuordnung zur aktuell empfohlenen Therapie erleichtern.

Schlussfolgerung Aufgrund der Häufigkeit und des Risikos potenziell lebensbedrohender Komplikationen sollte der OVT der Beinvenen eine größere Beachtung zukommen, insbesondere mit Blick auf eine spezialisierte Diagnostik durch Phlebologen.

Abstract

Introduction Superficial vein thrombosis (SVT) of the leg veins arises with an incidence of 0,5–1 per 1000 population per year and is complicated by associated thromboembolic events in 1 out of 4 cases. Thereby SVT is a frequent and serious venous disease. This review covers all relevant aspects of SVT based on the current scientific literature.

Methods This review article comprises the entire knowledge about SVT and is based on a systematic PubMed and Google Scholar search. Selective literature analysis based on a systematic PubMed search of publications between 1968 and 2018 with search terms “superficial vein thrombosis; thrombophlebitis” yielded in 102 relevant publications which were evaluated for this review. Part 1 of this work compiles aspects of definition, classification, etiology and diagnostics.

Results Besides the typical clinical signs of inflammation, SVT mainly presents as restiform induration on the leg, which is caused by a thrombotic occlusion of epifascial veins. The existence of varicose veins (68 % of cases), obesity (23 %), thrombophilia (18 %), and cancer (8 %) are the most important underlying diseases causing SVT. The average age of patients with SVT is 62 years; women are more often concerned than men (ratio 1.5:1). Increasing age is a significant risk factor. From the diagnostic point of view, it is crucial to describe the accurate extent of SVT, especially thrombus length and distance to the deep vein system.

This, and the diagnostic evaluation of the deep veins by means of compression ultrasound should be performed in a timely manner in each patient. We propose a classification of four types of SVT to facilitate the correct choice of treatment that is currently recommended.

Conclusion Because of its high frequency and the risk of potentially life-threatening complications SVT of the leg veins should be more focused, especially in terms of diagnostics as being performed by phlebologists.

Schlüsselwörter

oberflächliche Venenthrombose - Thrombophlebitis - Ätiologie - Klassifikation - Diagnostik

Key words

superficial vein thrombosis - thrombophlebitis - etiology - classification - diagnostics

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