Diagnosis and treatment of varicose veins complicated with acute superficial vein thrombosis: Summary of Ph.D. Thesis in Medical Sciences: 321.13 – Surgery

Abstract

The actuality of the topic. The thrombosis in the superficial veins of the lower extremities is defined as superficial venous thrombosis (SVT). It usually occurs spontaneously, often in persons with pre-existing varicose veins; for those cases the term acute varicothrombophlebitis (VTPh) being also used [1]. The rate of SVT reaches 3-11% in the general population [2, 3], but the exact annual incidence of the disease seems to be significantly higher [4]. For instance, in the United States alone it is estimated to be about 125,000 cases per year. It is supposed that the prevalence of SVT may be approximately two times higher that of deep vein thrombosis (DVT) and pulmonary thromboembolism [5]. Even previously SVT was considered a clinical entity with a benign, self-limiting evolution, actually SVT is seen as a pathology with an unpredictable clinical course. Moreover, recent publications in the field highlight a surprisingly high rate of associated thromboembolic events in this category of patients [6, 7, 8]. Apparently, the diagnosis of VTPh in patients with varicose veins of the lower limbs does not present difficulties. It is based on objective assessment and anamnestic data collection – identification the signs of local inflammation, pain, presence of edema, hyperemia and induration at the level of varicose vein. However, clear data on the diagnostic accuracy of clinical evaluation in patients with VTPh are lacking in the scientific literature. In addition, the local clinical modifications do not reveal the real extension of the thrombotic process [3, 9]. In this context, Duplex ultrasound (DUS) is currently considered as an instrumental examination of choice for confirmation / exclusion of SVT; however, dynamic imaging evaluation, especially in the cohort of patients undergoing surgical treatment, is not a common practice yet [10, 11]. The results of such an examination, performed in all patients in order to monitor the entire venous system of the extremities with the identification of possible changes at different intervals of time from the beginning of the treatment, would be very useful in assessing the dynamics of the pathological process, comparing the efficacy and safety of different curative strategies. The practical significance of the changes identified in laboratory analysis in patients with acute VTPh is not specified, and the role of routine testing and biomarkers derived from common lab tests remains to be studied supplementary. The diagnostic and prognostic value of other paraclinical examination, such as the determination of blood viscosity or the assessment of indices of thromboelastography has not been studied in practice in these patients so far. [...]