Conservative treatment of superficial vein thrombosis involving saphenous junction in patients with varicose veins of lower limbs: case series

Abstract

Introduction. Although the treatment of superficial vein thrombosis (SVT) remains controversial, thrombus extension to the level of sapheno-femoral (SFJ) or the saphenopopliteal junction (SPJ) usually serves as indication for urgent surgery. Vice-versa, there is a strong evidence about effectiveness of conservative management of junctional thrombosis developed after thermal ablation of saphenous trunk (endovenous heat induced thrombosis). Aim of the study. Aim of study was to evaluate the results of conservative treatment of SVT involving SFJ/SPJ in patients with varicose veins of lower limbs. Materials and methods. We retrospectively reviewed the prospectively maintained database of the patients with varicose veins complicated by SVT, treated in the department during the last 3 years. Extension of the thrombus up to the level of SFJ/SPJ (proximal to pre-terminal valve) but without involvement of the deep veins detected by duplex ultrasound was considered as inclusion criteria. Patients supposed to urgent surgical procedures were excluded. Patients were monitored for 3 months clinically and by duplex ultrasound. Results. From 106 patients (110 limbs) included into database, 15 patients satisfied the inclusion criteria for this study. There were 6 (40%) SVT cases with thrombosis of SPJ and 9 (60%) cases with implication of SFJ. Mean duration of SVT at the moment of admission was 6.5±4.3 days. Decision to treat patient conservatively was done basing on the patient refuse from surgical intervention or presence of important comorbidities. Patients were treated with oral rivaroxaban in the following doses: 20mg once a day 4 (36%) patients and 15mg twice a day 7 (64%) patients. Four patients (26%) were treated in outpatient conditions. The median duration of anticoagulant treatment was 62 days (range 45-180 days 25%-75% IQR 56-104). To the end of 3 months follow-up the complete recanalization of junction and saphenous trunk was detected in 12 (80%) patients, partial recanalization – in 3 (20%) patients. No cases of thrombosis progression, recurrence, development of deep vein thrombosis and symptomatic pulmonary embolism were registered during follow-up. Conclusions. Initial experience of anticoagulant treatment in case of SVT with involvement of the junctions with deep veins demonstrated safety and efficacy of conservative curative approach.