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Superficial Thrombophlebitis: Ligation vs. Anticoagulation



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Am Fam Physician. 2002 May 15;65(10):2150.

Lower extremity superficial thrombophlebitis is usually treated conservatively with compression support, nonsteroidal anti-inflammatory drugs (NSAIDs), and lower extremity elevation. Above-knee superficial thrombophlebitis (AK-STP) can result in pulmonary embolism, either directly or by extension into the deep venous system. Although anticoagulation is the most effective approach to reduce pulmonary embolism in patients with AK-STP and deep venous involvement, the optimal approach to AK-STP without extension is unclear. Operative interventions, including ligation of the saphenofemoral venous junction, and ligation and stripping of the phlebitis vein, are effective in reducing the incidence of pulmonary embolism. Another intervention is the use of anticoagulants as the only treatment. Sullivan and associates reviewed the literature to compare surgical with medical treatment of AK-STP without deep venous involvement.

Six studies were found that matched all of the exclusion and inclusion criteria. The two types of surgical interventions used were ligation of the greater saphenous vein at the saphenofemoral junction and ligation in combination with stripping of phlebitic veins, with or without perforator interruption. The medical intervention consisted of initial intravenous heparin followed by warfarin therapy for six weeks to six months, depending on extension into the deep venous system.

Surgical treatment of AK-STP appears to significantly reduce pain as well as superficial thrombus extension more rapidly than conventional medical therapy. Surgery has a fast recovery period and minimal bleeding risk. Medical treatment with anticoagulant therapy more effectively prevents pulmonary embolism, minimizes morbidity, and preserves the greater saphenous vein for future use in bypass procedures.

The authors conclude that, based on the current literature, a conclusion cannot be drawn as to the superiority of surgical versus anticoagulant therapy for AK-STP without deep venous extension. The utility of low-molecular-weight heparin versus intravenous unfractionated heparin remains unclear. So does the appropriate duration of medical anticoagulation therapy; six weeks of anticoagulation appears appropriate followed by additional anticoagulation if concomitant deep venous thrombosis or extension into the deep venous system is noted on follow-up duplex ultrasound scanning.

Sullivan V, et al. Ligation versus anticoagulation: treatment of above-knee superficial thrombophlebitis not involving the deep venous system. J Am Coll Surg. 2001;193:556–62.



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