Thrombophlebitis of the proximal great saphenous vein: hazard of extension into the deep venous system and management

ABSTRACT

Superficial thrombophlebitis [STP] of the proximal great saphenous vein [GSV] has long been considered a benign and self limiting disease. Possible extension into the deep system alerted authors to be cautious about proximal STP. Incidence of deep system extension varies between 7-44%. Another hazard of STP is pulmonary embolism [PE] with rates ranging between 3-33%. To study the incidence of direct extension of GSV proximal thrombophlebitis into the deep system in a group of patients having above knee GSV thrombophlebitis together with the efficacy and safety of direct thrombectomy of this extension. Two hundred cases of acute above knee GSV thromhophlebitis. Color Duplex of the venous system of the limb to show the position of the thrombus within the GSV, and its extension into the deep system, and if it is a fresh thrombus was done. Thrombectomy of all the cases [using fogarty catheter], that showed extension into the deep venous system, under protection of a high positive end expiratory pressure [PEEP] anesthesia to guard against intra-operative PE using 20 cm water pressure, with SFJ ligation, and GSV stripping, if that was varicosed. The cases were put on anticoagulation for 3 months post operatively. Ventilation/perfusion lung scan for the operated cases were performed Post operative venous duplex at 10 days, 1, 3 months, to study patency, flow and reflux in the deep system at the CFV, SFV and rest of the deep system. The propagation of thombosis form the proximal saphenous vein via SFJ into the deep system was noticed in 11% of the studied 200 cases. It was also thought that the thrombus has to extend to the deep system before being able to cause pulmonary embolism. 3% had probability result for PE. The use of positive end expiratory pressure [PEEP] was meant to prevent pulmonary embolism. The post operative color duplex survey showed normal venous morphology and function in 90.9% of cases, and accepted reasonable results in 9.1%. the use of direct thrombectomy of STP of the GSV in such described circumstances to improve deep venous patency, and lessen the post deep venous thrombosis sequalae