Thrombophlebitis of the Greater Saphenous Vein - Recommendations for Treatment

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Stephen L. Hill, M.D., Dorise H. Hancock, RT-R, Tanya L. Webb, BS, RVT.
Carilion Health Systems, Roanoke, VA, USA.

OBJECTIVES: Thrombophlebitis of the greater saphenous vein has been viewed as a superficial thrombophlebitis and, as such, treated with anti-inflammatories, heat, elevation, and, occasionally, antibiotics. It is considered to be a self limited process with minimal threat of propagation into the common femoral vein causing extensive deep venous thrombosis or pulmonary emboli. We have noted over the past several years that many thromboses of the greater saphenous vein do propagate to the fossa ovalis and can cause these serious complications.
METHODS: In order to quantitate the frequency of greater saphenous vein thrombosis and evaluate its possible morbidity, we reviewed all the venous studies in a Level I Trauma Center over one year. The charts of all patients who had a thrombus in the greater saphenous vein, either alone or in combination with a deep venous thrombosis, were examined. In the group with thrombophlebitis of the greater saphenous vein only, some patients had follow up duplex scans which confirmed the cephalad propagation of thrombus - necessitating medical anticoagulant therapy or surgical intervention.
RESULTS: There were a total of 2,646 lower extremity venous scans done the year studied. In this group there were 388 (14.5%) positive studies for a deep venous thrombosis. There were 36 (9.3%) patients in this group who had a deep venous thrombosis of the lower extremity and a thrombus in the greater saphenous vein. In 27 of these patients (75%), the thrombus of the greater saphenous vein was in contiguity with the deep venous thrombosis, thus either contributing to, or causing, the thrombosis. In the total group there were 30 patients (1.1%) with a superficial thrombophlebitis of the greater saphenous vein alone. In these patients, 22 (73%) either showed cephalad progression of the thrombus, symptoms of shortness of breath, a mobile tip in the thrombus, or extension of the thrombus into the common femoral vein. Five patients (16.6%), after failing medical therapy, underwent a surgical approach with ligation and division of the greater saphenous vein at the saphenofemoral junction and thrombectomy of the common femoral vein.
CONCLUSIONS: Thrombophlebitis of the greater saphenous vein, although not very common, needs to be carefully followed with a repeat duplex scan to determine if there is propagation of the thrombus in a cephalad direction or resolution .Our study shows that as many as 73% of patients with it can develop significant complications if left undetected. If there is cephalad propagation of the thrombus, anticoagulant treatment is indicated; if the thrombus propagates into the fossa ovalis, surgical management is necessary. The surgical approach requires ligation and division of the saphenofemoral junction and, if needed, thrombectomy of the common femoral vein.

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