Superficial Vein Thrombosis: Risk Factors, Diagnosis, and Treatment

Abstract

Superficial vein thrombosis (SVT) is a very common disease even though its incidence has never been assessed properly. Until recently, the literature on this topic has been relatively poor, old, and with numerous methodologic drawbacks, probably because this disease was considered benign and trivial. However, the recent recognition of a frequent association with concomitant venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]) and the risk of subsequent VTE complications in patients with isolated SVT has revived interest and has encouraged new clinical research. SVT and VTE share many common predisposing risk factors. Even if varicose veins represent the main cause of SVT, several underlying conditions (e.g., malignancy, thrombophilia, autoimmune diseases) should be sought, especially in idiopathic, migrant, or recurrent SVT of nonvaricose vein patients. The diagnosis is made in a clinical setting but ultrasonography is useful to identify concomitant asymptomatic DVT. Many medical and surgical treatments have been suggested to relieve local symptoms and signs, prevent recurrences, and limit the VTE risk of SVT, but the evidence coming from the limited number of prospective randomized studies does not allow strong recommendations on the optimal treatment of SVT.

Fondaparinux for the Treatment of Superficial-Vein Thrombosis in the Legs

“…28 Fondaparinux also reduced the risk of symptomatic recurrence of superficial-vein thrombosis and, more important, its extension to the saphenofemoral junctiona finding that is clinically relevant because such extension is considered to increase the risk of deep-vein thrombosis and pulmonary embolism, thereby prompting escalation of therapy (e.g., to full-dose anticoagulation or surgery). 1,2,6,8,10,11,14 In our study, fondaparinux reduced by 81% the rate The primary efficacy outcome was a composite of death from any cause, symptomatic pulmonary embolism, symptomatic deep-vein thrombosis, or symptomatic extension to the saphenofemoral junction or symptomatic recurrence of superficial-vein thrombosis. Data from patients who were lost to follow-up were censored at the time of the last contact.…”

“…3,4 Patients with isolated superficial-vein thrombosis -that is, without concomitant deep-vein thrombosis or symptomatic pulmonary embolism at presentation -are at risk for subsequent symptomatic venous thromboembolic complications. [1][2][3][4][5][6][7] In a large, prospective, observational study, the 3-month risk of such complications was 8.3%, with a 3.3% risk of deep-vein thrombosis or pulmonary embolism. 8 The treatment of this disease has not been adequately addressed in randomized trials.…”

“…7,9 This design was considered to be ethical, since all the patients benefited from close clinical monitoring, with adequate diagnostic procedures performed in the event of new or persistent symptoms, and since an independent data and safety monitoring committee carefully oversaw the study outcomes. The patients in our study are representative of those encountered in routine practice 1,2,8 : almost all were outpatients, and there was a clear predominance of women and a substantial proportion of obese patients, most presenting with varicose veins and superficial-vein thrombosis involving the great saphenous vein. The rate of symptomatic thromboembolic complications in the placebo group at day 47 (5.9%; 95% CI, 4.7 to 7.2) was in the low range of the expected rate of thromboembolic events, possibly because very-high-risk patients (e.g., those with active cancer or a recent history of venous thromboembolism and those in whom the thrombus was located within 3 cm of the saphenofemoral junction) were not enrolled in this placebo-controlled trial.…”

Risk factors for superficial vein thrombosis in patients with primary chronic venous disease

“…Superfi cial vein thrombosis (SVT) is a very common condition most often associated with chronic venous disease (CVD) [1]. In the Calisto trial, for example, almost 90 % of patients with acute, symptomatic SVT suff ered from varicose veins [2].…”

“…malignancy, thrombophilia, and autoimmune disease) are also described in relation to idiopathic, migrant or recurrent SVT [1]. Apart from CVD, obesity, older age, female sex, cigarette smoking, oral contraceptives and hormone replacement therapy are other frequently recognised risk factors [4].…”