[Superficial thrombophlebitis in non varicose veins of the lower limbs. A prospective analysis in 42 patients]

Abstract

Recent publications allow better understanding of superficial thrombophlebitis (ST) of the lower limb veins. However ST occurring in non varicose veins (NVV) and those occurring in varicose veins (VV) are seldom distinguished in literature.

Aims of the study: 1) To estimate the potential gravity of ST occurring in NVV by putting a figure on the frequency of associated deep venous thrombosis (DVT) and symptomatic pulmonary embolism (PE); 2) to identify some risk factors (thrombophilia, systemic disease, thromboembolic events); 3) to assess the different types of thromboembolic recurrent events after superficial thrombophlebitis (TRST) and identify the risk factors for recurrence.

Material and method: Forty-two cases of ST occurring in NVV were included consecutively and prospectively in this series; TRST possible risk factors were evaluated. Patients were assessed at 1 month and followed up to 3 years. Isolated ST was treated with low-molecular-weight heparin at prophylactic dosage from 15 to 21 days and with elastic compression.

Results: 1) A DVT was combined in 12 cases (28.6%) located in the calf (n=9) or in the femoro-politeal axis (n=3). One symptomatic PE occurred confirmed by ventilation-perfusion lung scan; 2) The risk factor investigations identified a neoplasm in 2 patients (4.8%), a non neoplasic systemic disease in 4 (9.5%) and a thrombophilia in 20 patients. The most frequent thrombophilia was the heterozygous mutation of coagulation factor V (Leiden); 3) All patients were assessed at 1 month with a clinical examination and Duplex Scanning. We did not identify either new DTV, PE or extension of the previous DVT; 4) 17 TRST were identified in 13 patients. Three patients had 2 recurrences; one patient presented a TRST located at 2 different sites. In total 8 new ST and 9 DVT were identified.

Discussion: The analysis of the literature shows that early complications or combinations (DVT and PE) occur with the same prevalence in NVV and VV groups. A risk factor was identified in 62% of patients in this series (thrombophilia was the most common) and TRST were statistically more frequent in this series than in groups of ST occurring in VV we had previously analyzed. A post-thrombotic syndrome and a DVT associated with the ST were identified as statistically significant risk factors for recurrence.

Conclusion: ST occurring in NVV, although representing 5 to 10% of all ST, is seldom reported in the literature. Like ST occurring in VV, they have a potential gravity (associated DVT and PE). However these two diseases should be distinguished. A risk factor is more often identified and TRST are more frequent in the group of ST occurring in NVV. We advise active management of these thromboses including screening for a risk factor, the implementation of measures for preventing venous thrombosis recurrence and patient follow-up.