Ann Vasc Dis Vol. 9, No. 2; 2016; pp 85–90 ©2016 Annals of Vascular Diseases
Online May 4, 2016 doi:10.3400/avd.oa.16-00017
Original Article
Clinical Features and Developing Risks of Saphenous Vein Thrombophlebitis Hiroto Rikimaru, MD, PhD
We evaluated the clinical features and the risks of 14 patients with 14 limbs affected by saphenous vein thrombophlebitis from April 2007 to May 2013 and compared the results with patients undergoing operative repair of varicose veins (127 patients, 193 limbs) during the study period. The frequency of patients with a body mass index over 25 (78.6% vs. 35.3%, p = 0.0018), varicose change in the saphenous vein (78.6% vs. 6.2%, p 10 cm 5 cm 1 cm >10 cm >10 cm 0.9 cm 15 cm >10 cm
Floating of thrombus
Pulmonary embolism
+
+
SFJ: sapheno-femoral junction; M: male; F: female; GSV: greater saphenous vein; SSV: smaller saphenous vein; SPJ: saphenopopliteal junction; AK: above knee; BK: below knee
in the great saphenous vein (GSV), and in six cases, it formed in the small saphenous vein (SSV). The thrombus length measured in each patient ranged widely from a short, 3-cm distance to almost the entire length of the saphenous vein. Six cases were diagnosed as ascending thrombophlebitis because of a thrombus extension to the SFJ or SPJ (within 3 cm). Although the thrombus of five of these patients had already extended to near the SFJ or SPJ at their initial visit, only one patient, case number 1, displayed a thrombotic extension to the SFJ after their first visit to our hospital. One patient had a floating thrombus (case 9), and one was found to have an asymptomatic pulmonary embolism (case 13). Patients with GSV thrombosis underwent partial stripping of the GSV under spinal anesthesia within 2 days of their diagnosis of saphenous thrombosis. The patient with 86
a floating thrombus (case 9) required a femoral vein clamp before manipulation of the GSV. A side clamp of the femoral vein proximal to the SFJ was required for two patients with ascending thrombophlebitis (cases 1 and 7). Stripping using routine surgical procedures was performed on the other five patients. Three patients with an SSV thrombus distant from the SPJ received high ligation of the SSV without touching the thrombus under local anesthesia in a prone position within 2 days of their hospital visit. Anticoagulation therapy using warfarin was administered for 6 months to two patients (cases 2 and 3) with a thrombus that extended to near the SPJ that would likely require direct operative manipulation of the thrombosed vein. High ligation was performed after regression of the thrombus for these two patients. No surgery was performed in case 12 due to the Annals of Vascular Diseases Vol. 9, No. 2 (2016)
Clinical Features and Developing Risks of SVT Table 3 Risks of thrombosis Case no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Age
Sex
Vein
BMI
67 82 58 73 68 56 28 82 62 79 60 71 75 69
M M F F F M M F F M M M F F
GSV SSV SSV GSV GSV GSV SSV SSV GSV GSV GSV SSV SSV GSV
25.7 27.5 28.5 26.2 28.0 30.9 23.0 24.9 20.3 25.2 27.6 27.4 27.8 29.3
Varicose change of saphenous trunk
Thrombophlebitis of saphenous branch
+
+
+ + + + + + + + + +
DVT
Thrombophilia
Malignancy
Hormone therapy
Long time driving
+ +
+ + + + + +
+ + + (*1)
+ (*2)
*1: protein C deficiency. *2: lung cancer. M: male; F: female; BMI: body mass index; DVT: deep venous thrombosis; GSV: greater saphenous vein; SSV: smaller saphenous vein
presence of left lung cancer (squamous cell carcinoma, stage IV) that was identified by CT scan. The patient was transferred to another hospital for treatment. No anticoagulation therapy was administered after surgery, except for case number 13 who had an asymptomatic pulmonary embolism and was prescribed warfarin for 6 months. Compression therapy using an elastic stocking was generally prescribed for at least 3 weeks after surgery, and seven patients with superficial thrombophlebitis of a varicose vein were continued on compression therapy until their symptoms improved. The thrombotic risks of patients with saphenous thrombosis are presented in Table 3. One patient had Protein C deficiency (37% measured activity; 64%–146% of the standard level), and another patient was undergoing hormone therapy using estriol. Lung cancer was identified in one patient and the other one, being a truck driver, used to sit for extended periods of time. Other than the formerly well-established risks, some clinical features appeared to be found frequently in the patients with saphenous vein thrombosis through this study. The frequency of patients with a high BMI (more than 25) was 78.6% (11 of 14 cases). The frequency of patients with varicose changes of the saphenous trunk was also 78.6% (11 of 14 cases). Furthermore, of seven patients with thrombotic varices, we excluded two patients as their thrombi continued to the saphenous thrombi; the remaining five patients had thrombophlebitis of varicose vein isolated from the saphenous thrombus. Gathering two patients with deep venous thrombosis discontinued to the saphenous thrombus, 7 of 14 patients (50.0%) had more than one independent, simultaneous thrombosis. Annals of Vascular Diseases Vol. 9, No. 2 (2016)
To evaluate how these risks may possibly influence saphenous thrombosis, the rates for patients with predictable risks above those who underwent an operation for varicose veins (127 patients, 193 limbs; Group S) were evaluated and compared with those of patients with a saphenous thrombosis (Group T) during the same period. The background characteristics of patients in each group are presented in Table 4. There were no significant differences between the two groups in age, gender, number of incompetent veins, and CEAP classification. The number of patients presenting with each risk is reported in Table 5. The frequency of patients having a high BMI was 11 in 14 patients (78.6%) in Group T; this was significantly higher than that in Group S (35.3%; 42 of 119 patients, excluding 8 from the original 127 patients because their records did not list their body weight or height; p = 0.0018). The mean BMI value in Group T was also significantly higher than that in Group S (26.6 ± 2.68 vs. 24.4 ± 3.88; p = 0.039). Furthermore, the rate of patients with varicose change in Group T (78.6%; 11 of 14 limbs) was significantly higher than that in Group S (6.2%; 12 of 193 limbs; p
Online May 4, 2016 doi:10.3400/avd.oa.16-00017
Original Article
Clinical Features and Developing Risks of Saphenous Vein Thrombophlebitis Hiroto Rikimaru, MD, PhD
We evaluated the clinical features and the risks of 14 patients with 14 limbs affected by saphenous vein thrombophlebitis from April 2007 to May 2013 and compared the results with patients undergoing operative repair of varicose veins (127 patients, 193 limbs) during the study period. The frequency of patients with a body mass index over 25 (78.6% vs. 35.3%, p = 0.0018), varicose change in the saphenous vein (78.6% vs. 6.2%, p 10 cm 5 cm 1 cm >10 cm >10 cm 0.9 cm 15 cm >10 cm
Floating of thrombus
Pulmonary embolism
+
+
SFJ: sapheno-femoral junction; M: male; F: female; GSV: greater saphenous vein; SSV: smaller saphenous vein; SPJ: saphenopopliteal junction; AK: above knee; BK: below knee
in the great saphenous vein (GSV), and in six cases, it formed in the small saphenous vein (SSV). The thrombus length measured in each patient ranged widely from a short, 3-cm distance to almost the entire length of the saphenous vein. Six cases were diagnosed as ascending thrombophlebitis because of a thrombus extension to the SFJ or SPJ (within 3 cm). Although the thrombus of five of these patients had already extended to near the SFJ or SPJ at their initial visit, only one patient, case number 1, displayed a thrombotic extension to the SFJ after their first visit to our hospital. One patient had a floating thrombus (case 9), and one was found to have an asymptomatic pulmonary embolism (case 13). Patients with GSV thrombosis underwent partial stripping of the GSV under spinal anesthesia within 2 days of their diagnosis of saphenous thrombosis. The patient with 86
a floating thrombus (case 9) required a femoral vein clamp before manipulation of the GSV. A side clamp of the femoral vein proximal to the SFJ was required for two patients with ascending thrombophlebitis (cases 1 and 7). Stripping using routine surgical procedures was performed on the other five patients. Three patients with an SSV thrombus distant from the SPJ received high ligation of the SSV without touching the thrombus under local anesthesia in a prone position within 2 days of their hospital visit. Anticoagulation therapy using warfarin was administered for 6 months to two patients (cases 2 and 3) with a thrombus that extended to near the SPJ that would likely require direct operative manipulation of the thrombosed vein. High ligation was performed after regression of the thrombus for these two patients. No surgery was performed in case 12 due to the Annals of Vascular Diseases Vol. 9, No. 2 (2016)
Clinical Features and Developing Risks of SVT Table 3 Risks of thrombosis Case no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Age
Sex
Vein
BMI
67 82 58 73 68 56 28 82 62 79 60 71 75 69
M M F F F M M F F M M M F F
GSV SSV SSV GSV GSV GSV SSV SSV GSV GSV GSV SSV SSV GSV
25.7 27.5 28.5 26.2 28.0 30.9 23.0 24.9 20.3 25.2 27.6 27.4 27.8 29.3
Varicose change of saphenous trunk
Thrombophlebitis of saphenous branch
+
+
+ + + + + + + + + +
DVT
Thrombophilia
Malignancy
Hormone therapy
Long time driving
+ +
+ + + + + +
+ + + (*1)
+ (*2)
*1: protein C deficiency. *2: lung cancer. M: male; F: female; BMI: body mass index; DVT: deep venous thrombosis; GSV: greater saphenous vein; SSV: smaller saphenous vein
presence of left lung cancer (squamous cell carcinoma, stage IV) that was identified by CT scan. The patient was transferred to another hospital for treatment. No anticoagulation therapy was administered after surgery, except for case number 13 who had an asymptomatic pulmonary embolism and was prescribed warfarin for 6 months. Compression therapy using an elastic stocking was generally prescribed for at least 3 weeks after surgery, and seven patients with superficial thrombophlebitis of a varicose vein were continued on compression therapy until their symptoms improved. The thrombotic risks of patients with saphenous thrombosis are presented in Table 3. One patient had Protein C deficiency (37% measured activity; 64%–146% of the standard level), and another patient was undergoing hormone therapy using estriol. Lung cancer was identified in one patient and the other one, being a truck driver, used to sit for extended periods of time. Other than the formerly well-established risks, some clinical features appeared to be found frequently in the patients with saphenous vein thrombosis through this study. The frequency of patients with a high BMI (more than 25) was 78.6% (11 of 14 cases). The frequency of patients with varicose changes of the saphenous trunk was also 78.6% (11 of 14 cases). Furthermore, of seven patients with thrombotic varices, we excluded two patients as their thrombi continued to the saphenous thrombi; the remaining five patients had thrombophlebitis of varicose vein isolated from the saphenous thrombus. Gathering two patients with deep venous thrombosis discontinued to the saphenous thrombus, 7 of 14 patients (50.0%) had more than one independent, simultaneous thrombosis. Annals of Vascular Diseases Vol. 9, No. 2 (2016)
To evaluate how these risks may possibly influence saphenous thrombosis, the rates for patients with predictable risks above those who underwent an operation for varicose veins (127 patients, 193 limbs; Group S) were evaluated and compared with those of patients with a saphenous thrombosis (Group T) during the same period. The background characteristics of patients in each group are presented in Table 4. There were no significant differences between the two groups in age, gender, number of incompetent veins, and CEAP classification. The number of patients presenting with each risk is reported in Table 5. The frequency of patients having a high BMI was 11 in 14 patients (78.6%) in Group T; this was significantly higher than that in Group S (35.3%; 42 of 119 patients, excluding 8 from the original 127 patients because their records did not list their body weight or height; p = 0.0018). The mean BMI value in Group T was also significantly higher than that in Group S (26.6 ± 2.68 vs. 24.4 ± 3.88; p = 0.039). Furthermore, the rate of patients with varicose change in Group T (78.6%; 11 of 14 limbs) was significantly higher than that in Group S (6.2%; 12 of 193 limbs; p
