Low-Molecular-Weight Heparin Versus Saphenofemoral Disconnection for the Treatment of Above-Knee Greater Saphenous Thrombophlebitis: A Prospective Study

Abstract

The objective of this study was to assess the efficacy, safety, and cost of lowmolecularweight heparin compared to saphenofemoral disconnection for the treatment of internal saphenous proximal thrombophlebitis (SPT). Eighty-four consecutive patients diagnosed as presenting SPT alone (symptoms/echo-Doppler) were divided into 2 comparable groups treated with (1) saphenofemoral disconnection under local anesthesia with a short hospital stay (n=45) or (2) prospective enoxaparin on an outpatient basis for 4 weeks (n=39). Informed consent was obtained and inclusion, exclusion, and withdrawal criteria were established. Patients were followed up at 1, 3, and 6 months. Thirty patients per group completed the study requirements. In the disconnection group, 2 patients (6.7%) presented complications of the surgical wound, 1 (3.3%) had SPT recurrence (however, there was no deep venous thrombosis), and 2 (6.7%) had nonfatal pulmonary embolism confirmed by radionuclide scan. In the enoxaparin group, there were 2 cases (6.7%) of minor bleeding (epistaxis and rectal bleeding) and 3 (10%) recurrences of SPT. In the enoxaparin group there was no case of progression of the thrombosis to the deep venous system or pulmonary embolism. The study found no statistically significant differences between saphenofemoral disconnection and enoxaparin in the treatment of SPT, but the low-molecular-weight heparin group had socioeconomic advantages.

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References

Lohr JM , McDevitt DT , Lutter KS , et al: Operative management of greater saphenous thrombophlebitis involving the sapheno-femoral junction. Am J Surg 164:269-275, 1992.

Ascer E , Lorensen E , Pollina RM , et al: Preliminary results of a nonoperative approach to saphenofemoral junction thrombophlebitis. J Vasc Surg 22:616-621, 1995.

Chengelis DL , Bendick PJ , Glover JL , et al: Progression of superficial venous thrombosis to deep vein thrombosis. J Vasc Surg 24:745-749, 1996.

Hushni EA , Williams WA : Superficial thrombophlebitis of lower limbs. Surgery 91:70-74, 1982.

Gould MK , Dembitzer AD , Doyle RL , et al: Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med 130:800-809, 1999.

Ginsberg JS : Management of venous thromboembolism. N Engl J Med 334:1816-1828, 1996.

Lozano F , GÛmez-Alonso A , Almaz·n A , et al: Ambulatory treatment of deep venous thrombosis: A guide to patient selection. Scope Phlebol Lymphol 4:200-204, 2000.

Polak JF : Peripheral Vascular Sonography. Baltimore: Williams and Wilkins, 1992.

Lozano F : Ligadura del cayado de la vena safena interna. In: Manual de Tècnicas Quirúrgicas, ed. by S·nchez Fern·ndez J. Madrid: Dìaz de Santos, 1992, pp 178-186.

10.

Siragusa S , Cosmi B , Piovella F , et al: Lowmolecularweight heparin in the treatment of patients with acute venous thromboembolism: Results of a metaanalysis. Am J Med 100:269-277, 1996.

11.

Levine M , Gent M , Hirsh J , et al: A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep vein thrombosis. N Engl J Med 334:677-681, 1996.

12.

Koopman MMW , Prandoni P , Piovella F , et al: Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 334:682-687, 1996.

13.

Hafner CD , Cranley JJ , Krause RJ , et al: A method of managing superficial thrombophlebitis. Surgery 55:201-206, 1964.

14.

Murgia AP , Cìsno C , Pansini GC , et al: Surgical management of ascending saphenous thrombophlebitis. Int Angiol 18:343-347, 1999.

15.

Blumenberg RM , Barton E , Gelfand ML , et al: Occult deep venous thrombosis complicating superficial thrombophlebitis. J Vasc Surg 27:338-343, 1998.

16.

Hanson IN , Ascher E , DePippo P , et al: Saphenous vein thrombophlebitis: A deceptively benign disease. J Vasc Surg 27:677-680, 1998.

17.

Verlato F , Zucchetta P , Prandoni P , et al: An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg 30:1113-1115, 1999.

18.

Jorgensen JO , Hanel KC , Morgan AM , et al: The incidence of deep venous thrombosis in patients with superficial thrombophlebitis of the lower limbs. J Vasc Surg 18:70-73, 1993.

19.

Skihnan JJ , Kent KC , Porter DH , et al: Simultaneous occurrence of superficial and deep thrombophlebitis in the lower extremity. J Vasc Surg 11:818-824, 1990.

20.

Belcaro G , Nicolaides AN , Errichi BM , et al: Superficial thrombophlebitis of the legs: A randomized, controlled, follow-up study. Angiology 50:523-529, 1999.