Management of non varicose superficial vein thrombosis: single-centre experience

Background: Very little information is available about the occurrence of non varicose superficial vein thrombosis (NV-SVT) in the general population and its appropriate management.

The aim of this study was to show our experience in management of patients with NV-SVT, to improve our understanding of predisposing risk factors for NV-SVT, to assess concomitant and recurrent thromboembolic events (DVT, PE, recurrence of the NV-SVT)

Materials/Methods: Over a 5 year period, between January 2008 to January 20013, 22 patients (19 males and 3 females; mean age 38 years) were diagnosed with NV-SVT of lower limbs(LL). All NV-SVT involved great saphenous vein (GSV) with proximal level of acute thrombosis located in the upper third of the thigh.

Crossectomy was performed in all cases. After an initial course of intermediate-dose LMWH therapy patients were anticoagulated with VKA(INR 1,5-2) for at least 6 months.

In the follow-up patients were assessed clinically and with duplex ultrasound (DUS) at least once a year. Investigation for risk factors and thrombophilia was also carried out.

Results: At the time of presentation 5 patients had a history of NV-SVT of the contralateral LL confirmed by DUS. 2 patients had concomitant NV-SVT of the contralateral  distal GSV. No signs of concurrent DVT were found.

After discontinuing of oral anticoagulation 3 patients developed NV-SVT in the contralateral LL, 1 patient had symptomatic DVT of femoropopliteal segment. 1 patient, with malignancy died of possible PE despite anticoagulation.

The most frequent risk factors observed in our study were: inherited thrombophilia – 10 patients(heterozygous mutations of factor V(Leiden), prothrombin G20210A, MTHFR and their combinations), Buerger’s disease-2 patients, antiphospholipid syndrome-2 patients,  malignancy-2 patients, contraceptive use-1 patient. 

Conclusions: We propose active management of NV-SVT, including screening for risk factors, surgical high ligation of superficial truncal veins, and prolonged anticoagulation in order to prevent the extension of thrombus  formation into the deep veins as well as prevent recurrent thromboembolic events.

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