[Diagnosis and therapy of progressive thrombophlebitis of epifascial leg veins].
BACKGROUND
The thrombophlebitis is generally regarded as a harmless disease. However, the progressive varicophlebitis represents a subgroup of thrombophlebitis in which the proximal portion of the thrombus can ascend into the deep vein system with the complication of deep vein thrombosis or pulmonary embolism.


METHODS
In a period of 15 months ten patients were operated upon in whom a progressive varicophlebitis was diagnosed with color-flow duplex scanning. Eight of them were men, two were women. The average age was 56 years.


RESULTS
Nine patients had an ascending thrombosis of the greater saphenous vein. One patient had the origin of the thrombus in the shorter saphenous vein. In one patient the ascending thrombosis of the greater saphenous vein was the reason for a segmental pulmonary embolism. The indication for operation was given when the proximal portion of the thrombus was within 10 cm of the confluence to the deep vein system. The operative procedure comprised the ligature of the epifascial vein.


CONCLUSIONS
The diagnosis of thrombophlebitis should not be restricted only to clinical examination. Color-flow duplex scanning is preferred to compression venous ultrasonography. The ascending contrast venography as invasive diagnostic procedure should only be performed for the clarification of further questions. In ascending varicophlebitis ligature of the confluence from the superficial to the deep vein system is a safe procedure to avoid a progression of the disease or embolism. In case of postoperative recanalisation of the superficial varicose vein a second operation with stripping of the vein can be performed.
Denzel
C
C
Abteilung für Gefässchirurgie, Chirurgische Klinik mit Poliklinik der Friedrich-Alexander-Universität, Erlangen-Nürnberg.
Lang
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W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color