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[Crossectomy in ascending superficial thrombophlebitis of the leg veins]
H J Kock1, U Krause, K H Albrecht
1Abteilung für Allgemeine Chirurgie, Universitätsklinikum Essen.
Insights
Ascending thrombophlebitis can spread to deep leg veins, posing a risk of embolism. Duplex sonography showed this condition can still lead to deep vein thrombosis and thromboembolism despite diagnosis.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Thrombosis Research
Background:
- Ascending thrombophlebitis of superficial leg veins is a known precursor to deep vein involvement and embolism.
- The clinical significance and diagnostic accuracy of sonography in predicting deep vein propagation require further investigation.
Purpose of the Study:
- To prospectively evaluate the incidence of deep vein thrombosis and embolism in patients diagnosed with ascending thrombophlebitis using sonography.
- To assess the effectiveness of duplex sonography in preventing thrombus propagation into deep veins.
Main Methods:
- Prospective follow-up of 44 patients with sonographically diagnosed ascending thrombophlebitis.
- Intraoperative assessment of thrombosis in crossing veins and presence of floating thrombi.
- Monitoring for treatment complications, including recurrence and thromboembolic events.
Main Results:
- 34% of patients had thrombosis in crossing veins, and 14% had floating thrombi extending into deep veins.
- 11.4% of patients experienced treatment complications, including thrombus recurrence, pulmonary embolism, and femoral vein thrombosis.
- Duplex sonography was not consistently effective in preventing deep vein thrombus propagation in 11% of cases.
Conclusions:
- Ascending thrombophlebitis poses a significant risk of deep vein involvement and thromboembolism.
- While sonography aids diagnosis, it does not always prevent thrombus propagation into deep veins.
- Thromboembolism remains a potential complication of ascending thrombophlebitis, necessitating vigilant management.
Abstract:
Ascending thrombophlebitis of the superficial leg veins is known to propagate into the deep leg veins and to embolize. In a prospective study we followed up 44 patients with sonographically diagnosed ascending thrombophlebitis into the deep veins (V. saphena magna n = 40, V. saphena parva n = 4). In 15 of 44 cases (34%) thrombosis of the crossing veins was found intraoperatively and 6 of 44 crossings were filled with floating thrombi into the deep vein lumina (14%). Among complications of treatment (11.4%) recurrence of thrombi in the ligated superficial residual vein stump was seen in 2 of 44 cases. One of these patients suffered a symptomatic, non-fulminant pulmonary embolism. The other patient developed a femoral vein thrombosis. 1 patient had an abscess and 1 a seroma of the groin. In 11% of all cases ascending thrombophlebitis diagnosed duplex sonographically was not effective in preventing propagation of thrombi into the deep veins thromboembolism remains a complication of ascending thrombophlebitis.