Current aspects of diagnosis and treatment of surface thrombosis of the leg

Summary

The term „superficial venous thrombosis” (SVT) is more suitable to characterize the impact of the underlying disease instead of the old term „thrombophlebitis”, since 25% of the patients have additional thrombembolic complications as a deep venous thrombosis or pulmonary embolism. If SVT is found in varicose veins, these veins should be therapied after the healing of the acute thrombosis. SVT independent of varicose veins are often seen in patients with malignancies, thrombophilia and other risk factors oft he deep vein thrombosis. Although the diagnosis of SVT could be made by clinical findings a creful duplex is essential to detect the extend of the thrombus and the exact location – perhaps with progress into the deep venous system. The complete venous system of both legs should be examined as the main reason for the SVT is hypercoagulability. Therefore, concomitant deep venous thrombosis can be detected on the same but also on the other leg. The therapy of SVT depends on the affected vein: 1) In small tributary veins cooling, compression therapy and nonsteroidal antiinflammatory drugs as well as a small inzision and expression of the thrombus are sufficient. 2) In SVT of saphenous veins and larger tributaries with a length of 5cm or more, anticoagulation in prophylactic dose for 4–6 weeks and compression treatment for 3 months is recommended. In patients with risk factors like cancer, autoimmune disease or SVT in non-varicose veins, thromboembolic complications are often seen after the end of the 6-weeks anticoagulation. In these patients special instructions are helpful. 3) A SVT nearby (<3cm) the crossing to the deep venous system or with extend into the deep venous system should be treated like a deep venous thrombosis.

Keywords

Superficial venous thrombosis - heparin - compression - fondaparinux - rivaroxaban - duplex

Interessenkonflikt

Nach Angaben der Autoren bestehen keine Interessenkonflikte.

• Literatur

• 1 Di Minno MN, Ambrosino P, Ambrosini F, Tremoli E, Di Minno G, Dentali F. Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost. 2016. May; 14(05) 964-72 doi: 10.1111/jth.13279. Epub 2016 Mar 15.
• 2 Dua A, Heller J, Patel B, Desai S. Variability in the Management of Superficial Venous Thrombophlebitis across Practitioners Based in North America and the Global Community. Thrombosis 2014; 2014: 306018 doi: 10.1155/2014/306018. Epub 2014 Oct 12.
• 3 Frappé P, Buchmuller-Cordier A, Bertoletti L, Bonithon-Kopp C, Couzan S, Lafond P, Leizorovicz A, Merah A, Presles E, Preynat P, Tardy B, Décousus H. STEPH Study Group. Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community-based study. J Thromb Haemost 2014; 12 (06) 831-838.
• 4 Cannegieter SC, Horváth-Puhó E, Schmidt M, Dekkers OM, Pedersen L, Vandenbroucke JP, Sørensen HT. Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study. Blood 2015; 125 (02) 229-235.
• 5 Cosmi B, Filippini M, Campana F, Avruscio G, Ghirarduzzi A, Bucherini E, Camporese G, Imberti D, Legnani C, Palareti G. Risk factors for recurrent events in subjects with superficial vein thrombosis in the randomizes clinical trail SteFlux (Superficial Thromboembolism Fluxum). Thromb Res 2014; 133 (02) 196-202.
• 6 Karathanos C, Spanos K, Saleptsis V, Tsezou A, Kyriakou D, Giannoukas AD. Recurrence of superficial vein thrombosis in patients with varicose veins. Phlebology. 2015 Jul 16.
• 7 Frappé P, Bertoletti L, Presles E, Buchmuller-Cordier A, Merah A, Le Hello C, Peycelon D, Tardy B, Décousus H. Seasonal variation in the superficial vein thrombosis frequency. Thromb Res 2015; Dec; 136 (06) 1116-1119.
• 8 Lattimer CR, Kalodiki E, Geroulakos G, Syed D, Hoppensteadt D, Fareed J. d-Dimer Levels are Significantly Increased in Blood Taken From Varicose Veins Compared With Antecubital Blood From the Same Patient. Angiology 2015; Oct; 66 (09) 882-888.
• 9 Kantarcı UH, Dirik A, Öztürk YE, Kiriş İ, Duymuş M. Doppler Ultrasound and Magnetic Resonance Imaging Findings of Penile Mondor’s Disease: Case Report and Literature Review. Pol J Radiol. 2016 Feb 2; 81. 36-8 doi: 10.12659/PJR.895569. eCollection 2016.
• 10 Marsaudon E, Legal C, Gayoux D, Weber O. La maladie de Mondor pénienne: une observation. Rev Med Interne. 2016
• 11 Lee C, Moll S. Migratory superficial thrombophlebitis in a cannabis smoker. Circulation 2014; 130 (02) 214-215.
• 12 Sándor T. [Superficial venous thrombosis. A state of art]. Orv Hetil 2017; Jan; 158 (04) 129-138.
• 13 AWMF Leitlinie: Diagnostik und Therapie der Venenthrombose und der Lungenembolie. Verabschiedet. am 10. Oktober 2015
• 14 Decousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G, Leizorovicz A. Study Group. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 2010; Sep 23; 363 (13) 1222-1232.
• 15 Blondon M, Righini M, Bounameaux H, Veenstra DL. Fondaparinux for isolated superficial vein thrombosis of the legs: a cost-effectiveness analysis. Chest 2012; Feb; 141 (02) 321-329.
• 16 Beyer-Westendorf J, Schellong SM, Gerlach H, Rabe E, Weitz JI, Jersemann K, Sahin K, Bauersachs R. SURPRISE investigators. Prevention of thromboembolic complications in patients with superficial-vein thrombosis given rivaroxaban or fondaparinux: the open-label, randomised, noninferiority SURPRISE phase 3b trial. Lancet Haematol 2017; Mar; 04 (03) e105-e113.
• 17 Spirkoska A, Jezovnik MK, Poredos P. Time Course and the Recanalization Rate of Superficial Vein Thrombosis Treated With Low-Molecular-Weight Heparin. Angiology. 2014 May 7. [Epub ahead of print].