Surgical management of ascending saphenous thrombophlebitis

Acute saphenous vein ascending thrombophlebitis is recognised to be a dangerous condition due to the reported high incidence of deep vein thrombus involvement and possibly fatal pulmonary embolism. We assessed the accuracy of duplex scanning in determining the extent of thrombosis as well as the effectiveness of surgical treatment.

We retrospectively reviewed 146 patients referred to our Vascular Laboratory for acute superficial thrombophlebitis from 1987 to 1997. Duplex scanning identified 85 cases of superficial thrombophlebitis involving at least a segment of the saphenous vein localised below the knee (58.2%); 37 of thrombophlebitis extending into both the superficial and deep venous systems (25.3%), and 24 of saphenous thrombosis extending to within 5 cm of the saphenofemoral junction (16.4%). The latter group underwent saphenofemoral disconnection. We compared the preoperative duplex with the surgical reports and evaluated the surgical results.

We did not observe any complication. Return to work and normal activity occurred within 3-5 days. When varicose vein thrombectomy was performed concurrently, the patients had better postoperative pain control.

Duplex scanning showed 100% accuracy both in determining the presence of thrombosis and its extent. Saphenofemoral disconnection for thrombosis involving the saphenofemoral junction is a safe procedure and can be performed on an outpatient basis.