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A lot has happened in the diagnosis and therapy of patients with venous diseases in recent years. In a recent publication, Professor Markus Stücker (Vein Center of the Dermatology and Vascular Surgery Clinics, St. Maria-Hilf-Krankenhaus, Bochum) has shown what in everyday clinical practice at Venous disorders are important. The first episode of a three-part series deals with superficial vein thrombosis.
As Stücker explains, thrombosis of superficial veins can be caused by injuries; in the upper limb, this is most often done by intravenous access; on the legs it usually spontaneously comes to thrombosis in varicose veins.Superficial vein thrombosis of a normal vein can also be the result of thrombophilia or Buerger’s disease (thromboangiitis obliterans) in younger patients, according to the guideline of «European Society for Vascular Surgery», on which Stücker orients himself; in older patients, a malignant disease is also possible.
A superficial venous thrombosis is not a banal or benign disease, emphasize unanimously the authors of the guideline and also Stücker. According to the Bochum vein specialist, it is a serious disease and certainly more than just a «mood disorder». In about 25 percent of patients with such thrombosis in the «Prospective Observational Superficial Thrombophlebitis (POST) study», deep vein thrombosis or symptomatic pulmonary embolism were detected at the first presentation. And of the patients without primarily concomitant deep vein thrombosis or pulmonary embolism, around ten percent develop thromboembolic complications (DVT, PE and progressive or recurrent superficial vein thrombosis) within three months, according to Stücker.In addition, the risk of thromboembolic events persists throughout the three months after the diagnosis of superficial venous thrombosis, although the risk may be higher in the first month and then gradually decrease.
A typical finding in a superficial vein thrombosis is a tender, reddened and overheated strand, often in the legs in the area of pre-existing varicose veins, but also along the saphenous vein magna or, more rarely, along the saphena parva vein. Note the possibility of confusing thrombosis with a bacterial infection.
A duplex sonographic examination of the entire leg vein system is always indicated for superficial vein thrombosis of the legs, as patients with surface thrombosis may have concomitant deep vein thrombosis.
At least in the case of superficial vein thrombosis of the legs outside of varicose veins should be searched for a tumor, recommends the vascular specialist.The reason: Not only in deep vein thrombosis, but also in surface thrombosis, the cancer prevalence is significantly increased. In a recent study in patients with superficial vein thrombosis, the prevalence of a malignant comorbidity was almost nine percent in the overall group; of the patients with isolated superficial vein thrombosis, 4.2% were affected; in superficial vein thrombosis and concomitant deep vein thrombosis or pulmonary embolism, the proportion of patients with a malignant tumor was almost 19 percent.
What does the therapy look like? According to Stücker, there are no systematic studies on anticoagulant therapy for superficial venous thrombosis on the arms. A major reason for this is probably that thromboembolic complications are rare here. Treatment would often be with cooling and compression bandages.
In the case of superficial vein thrombosis of the legs, the following aspects are important for the therapeutic procedure, explains the vascular specialist based on the recommendations of the European Society of Vascular Surgery:
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the length of the thrombus,
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the proximity of the thrombus to the deep venous system and
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the combination with deep vein thrombosis.
the length of the thrombus,
the proximity of the thrombus to the deep venous system and
the combination with deep vein thrombosis.
It is of great importance that the anticoagulation is carried out over at least four to six weeks in order to have an effect.According to Stücker, here are the different therapy scenarios for superficial thrombosis of the legs:
Surface thrombosis <5 cm long and ≥ 3 cm from saphenofemoral or saphenopopliteal junction: Local cooling and compression, no medication
Surface thrombosis ≥ 3 cm from saphenofemoral or saphenopopliteal junction and ≥ 5 cm in length: fondaparinux 2.5 mg once daily for 45 days
Surface thrombosis <3 cm away from saphenofemoral or saphenopopliteal junction: anticoagulation over three months
Surface thrombosis together with deep vein thrombosis: Treatment of deep vein thrombosis according to guidelines.
The second episode of Varizen will be released on Friday in a week.
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