Superficial Vein Thrombosis and Severe Varicose Veins Complicating Venous Thromboembolism

Objective To investigate which factors other than history of superficial vein thrombosis (SVT) are associated with recurrent spontaneous SVT episodes in patients with varicose veins (VVs). Materials and methods Patients with a history of spontaneous SVT and VVs were followed up for a mean period of 55 months. Demographics, comorbidities, and thrombophilia screening test were analyzed. Patients were grouped according to the clinical–etiology–anatomy–pathophysiology classification. A multiple logistic regression analysis with the forward likelihood ratio method was undertaken. Results Thirteen patients out of 97 had a recurrence SVT episode during the follow-up period. All those patients were identified to have a thrombophilia defect. Protein C and S, antithrombin, and plasminogen deficiencies were more frequently present in patients without recurrence. Gene mutations were present in 38% in the nonrecurrence group and 77% in the recurrence group. After logistic regression analysis, patients with dislipidemia and mutation in prothrombin G20210A (FII) had an increased risk for recurrence by 5.4-fold and 4.6-fold, respectively. No deep vein thrombosis or pulmonary embolism occurred. Conclusions Dislipidemia and gene mutations of F II are associated with SVT recurrence in patients with VVs. A selection of patients may benefit from anticoagulation in the short term and from VVs intervention in the long term.

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Superficial Vein Thrombosis in Patients with Varicose Veins: Role of Thrombophilia Factors, Age and Body Mass

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2011.12.019 ◽

2012 ◽

Vol 43 (3) ◽

pp. 355-358 ◽

Cited By ~ 19

Author(s):

Ch. Karathanos ◽

G. Sfyroeras ◽

A. Drakou ◽

N. Roussas ◽

M. Exarchou ◽

...

Keyword(s):

Body Mass ◽

Varicose Veins ◽

Superficial Vein ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis

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The Epidemiology of Venous Thromboembolism in the Community

Thrombosis and Haemostasis ◽

10.1055/s-0037-1616243 ◽

2001 ◽

Vol 86 (07) ◽

pp. 452-463 ◽

Cited By ~ 313

Author(s):

David Mohr ◽

Tanya Petterson ◽

Christine Lohse ◽

W. Michael O’Fallon ◽

L. Joseph Melton ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Varicose Veins ◽

Hormone Replacement ◽

Malignant Neoplasm ◽

Venous Catheter ◽

The United States ◽

Venous Stasis ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis

SummaryThe incidence of venous thromboembolism exceeds 1 per 1000; over 200,000 new cases occur in the United States annually. Of these, 30% die within 30 days; one-fifth suffer sudden death due to pulmonary embolism. Despite improved prophylaxis, the incidence of venous thromboembolism has been constant since 1980. Independent risk factors for venous thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, malignancy, neurologic disease with extremity paresis, central venous catheter/ transvenous pacemaker, prior superficial vein thrombosis, and varicose veins; among women, risk factors include pregnancy, oral contraceptives, and hormone replacement therapy. About 30% of surviving cases develop recurrent venous thromboembolism within ten years. Independent predictors for recurrence include increasing age, obesity, malignant neoplasm, and extremity paresis. About 28% of cases develop venous stasis syndrome within 20 years. To reduce venous thromboembolism incidence, improve survival, and prevent recurrence and complications, patients with these characteristics should receive appropriate prophylaxis.

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Venous thromboembolism

Obstetric Medicine ◽

10.1093/med/9780198821540.003.0010 ◽

2020 ◽

pp. 363-372

Author(s):

Charlotte Frise ◽

Sally Collins

Keyword(s):

Risk Factors ◽

Molecular Weight ◽

Venous Thromboembolism ◽

Low Molecular Weight Heparin ◽

Superficial Vein ◽

Mortality And Morbidity ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis ◽

Maternal Mortality And Morbidity ◽

Deep Vein

Venous thromboembolism is a major cause of maternal mortality and morbidity. This chapter discusses thromboprophylaxis (including low-molecular-weight heparin and doses by patient weight), risk factors, deep vein thrombosis, pulmonary embolism, associated investigations, and management. Anticoagulants and bleeding while anticoagulated are both covered. Finally, superficial vein thrombosis in the first month postpartum is described.

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Accuracy of Reporting of Venous Thromboembolism in Hospitalized Patients.

Blood ◽

10.1182/blood.v114.22.557.557 ◽

2009 ◽

Vol 114 (22) ◽

pp. 557-557

Author(s):

Alejandro Perez ◽

Margie S. Hubman ◽

Craig Martin ◽

Jeannie Michaels ◽

John R. Bartholomew

Keyword(s):

Venous Thromboembolism ◽

Medical Record ◽

Conflicts Of Interest ◽

Healthcare Research ◽

Clinical Event ◽

Superficial Vein ◽

Reporting Practices ◽

Vein Thrombosis ◽

Diagnosis Codes ◽

Superficial Vein Thrombosis

Abstract Abstract 557 Introduction: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important clinical event that needs to be accurately reported. The Agency for Healthcare Research and Quality (AHRQ) has categorized VTE as a reportable patient safety indicator (PSI) and has distributed a software package for recording events such as VTE based upon diagnosis codes. At our institution, there was concern that VTEs identified by this software method may be over estimating the actual number. Objective: To verify the cases of VTE as identified by AHRQ methodology through a review of the medical record for each event reported. Methods: Through a review of the electronic medical record (EMR), the events recorded as a VTE by PSI software over a 7 month period from November 2008 to May 2009 were further characterized into categories of acute, remote or age indeterminate DVTs and were distinguished from events that were either isolated superficial vein thrombosis (SVT) or that were not VTE at all. Discharge summaries, hospital notes, operative reports and imaging reports were used to verify identified cases of VTE. VTE occurrences were grouped by the month of discharge of the patient. The PSI software utilized diagnosis codes that have been abstracted for a patient's hospitalization based upon physician documentation. Results: 437 events were recorded as VTE over a 7 month period. 59 cases (13.5%) were incorrectly coded as VTE. 35 cases (8.0%) were superficial vein thrombosis mistakenly classified as DVT. 12 cases (2.7%) had remote or age indeterminate DVTs. 12 cases (2.7%) cases had no VTE and were considered further abstraction errors. After interim reporting of the first 4 months of VTE data, vascular laboratory study reports were amended so that superficial vein thrombosis would no longer be identified by this terminology and would subsequently be classified as superficial vein thrombophlebitis. The last three months of data collection had 9 cases (4.7%) incorrectly identified as DVTs that were actually SVTs versus 26 cases (10.6%) prior to implementation of the nomenclature change. Conclusion: Hospitals must be aware of reporting practices in their own institution as national protocols may not completely depict individual hospital occurrences. Careful attention to the manner in which the medical record reflects events can make substantial difference in accounting of VTE occurrence. Because of the lack of specificity of current diagnosis coding guidelines, an appropriate medical term was not sufficient for medical record abstractors to categorize an event correctly in this study. As hospitals become monitored for quality of care with these methodologies, the accuracy of reporting becomes paramount. Disclosures: No relevant conflicts of interest to declare.

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Anatomical Predictors of Venous Thromboembolism Recurrence after Isolated Superficial Vein Thrombosis

Blood ◽

10.1182/blood.v126.23.651.651 ◽

2015 ◽

Vol 126 (23) ◽

pp. 651-651

Author(s):

Jean-Philippe Galanaud ◽

Marie-Antoinette Sevestre ◽

Céline Genty ◽

Susan R Kahn ◽

Gilles Pernod ◽

...

Keyword(s):

Venous Thromboembolism ◽

Board Of Directors ◽

Research Funding ◽

Superficial Vein ◽

Advisory Committees ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis ◽

The Impact

Abstract Background: Isolated superficial vein thrombosis (iSVT) (i.e. without concurrent deep-vein thrombosis or pulmonary embolism) is a frequent event. Its clinical significance and management are controversial. Data on long-term follow-up are scarce and the impact of anatomical characteristics of iSVT on the risk of venous thromboembolism (VTE) (DVT and/or PE) recurrence has not been assessed. Objective: To determine the impact of anatomical characteristics of iSVT on the long-term risk of VTE recurrence. Methods: Using data from the The OPTIMEV (OPTimisation de l'Interrogatoire dans l'_evaluation du risque throMbo-Embolique Veineux) study, a prospective, observational, multicenter study, we assessed at 3 years in patients recruited for an objectively confirmed iSVT i) cumulative rates of DVT, PE and SVT recurrences using the Kaplan-Meier method; and ii) anatomical predictors of VTE recurrence (SVT involving the sapheno-femoral junction (i.e. ≤3 cm), SVT of the trunk of the great saphenous vein, bilateral SVT, SVT occurring in a varicose vein (i.e. C≥2 according to CEAP classification) using a Cox multivariable model adjusted for age, sex, cancer and personal history of VTE. At baseline, all patients with SVT underwent a complete bilateral swhole leg ultrasound to exclude concurrent DVT and during follow-up, all suspected VTE recurrences were confirmed/ruled out with objective tests. All recurrences were centrally adjudicated by the study's expert committee. Results: Among the 479 recruited patients with iSVT, 12.5% (n=60) had a thrombotic recurrence during the 3 years of follow-up. Cumulative rates of recurrence as a PE, DVT and iSVT were 1.9%, 4.8% and 5.8%, respectively. In multivariate analysis, a thrombus involving the sapheno-femoral junction at baseline independently increased the risk of VTE recurrence (HR=3.34 [1.5-7.2]). Presence of varicose veins also increased the risk but this result did not reach statistical significance (HR=1.8 [0.9 - 3.9], p=0.11). Conclusion: In an unselected population of patients with iSVT, long-term risk of VTE recurrence is substantial. Involvement of the sapheno-femoral junction is a strong independent predictor of VTE during the subsequent 3 years. Our results suggest the need for more aggressive management and follow-up of patients with iSVT exhibiting this anatomical characteristic. Disclosures Galanaud: Daichi: Membership on an entity's Board of Directors or advisory committees, Research Funding; bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding. Sevestre:bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Daichi: Membership on an entity's Board of Directors or advisory committees, Research Funding. Pernod:pfizer: Consultancy; leo: Consultancy; bristol meyers: Consultancy; Daichi: Consultancy; bayer: Consultancy. Brisot:bayer: Membership on an entity's Board of Directors or advisory committees; daichi: Membership on an entity's Board of Directors or advisory committees. Quéré:3-M: Research Funding; thuasne: Research Funding; aspen: Research Funding; daichi: Membership on an entity's Board of Directors or advisory committees; bayer: Membership on an entity's Board of Directors or advisory committees; leo: Membership on an entity's Board of Directors or advisory committees.

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Treatment of Superficial Vein Thrombosis with Standardized Application of Essaven Gel

Angiology ◽

10.1177/0003319701052003s11 ◽

2001 ◽

Vol 52 (3_suppl) ◽

pp. S57-S62 ◽

Cited By ~ 9

Author(s):

M.T. De Sanctis ◽

M.R. Cesarone ◽

L. Incandela ◽

G. Belcaro ◽

M. Griffin

Keyword(s):

Skin Temperature ◽

Varicose Veins ◽

Local Treatment ◽

Controlled Study ◽

Superficial Vein ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis ◽

Effective Use ◽

And Control ◽

Average Skin

The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in comparison with placebo in 30 patients with superficial vein thrombosis (SVT). The 4-week study evaluated the average skin temperature and an analogue symptomatic score. Below-knee SVT was associated with large varicose veins. In patients treated with active EG the decrease in score and in the average, composite skin temperature was significantly larger than in the placebo and control groups. No intolerance was observed. The decrease in score and temperature in the placebo group was mainly due to skin manipulation and massage. In conclusion, treatment with EG in SVT improves symptoms and decreases skin temperature faster. This study confirms earlier observations on the effective use of EG in SVT.

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Diagnosis and treatment of superficial vein thrombosis

Hämostaseologie ◽

10.5482/hamo-13-04-0027 ◽

2013 ◽

Vol 33 (03) ◽

pp. 232-240 ◽

Cited By ~ 11

Author(s):

R. M. Bauersachs

Keyword(s):

Risk Factors ◽

Varicose Veins ◽

Epidemiological Data ◽

Clinical Findings ◽

Common Disease ◽

Superficial Vein ◽

Thromboembolic Complications ◽

Double Blind ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis

SummarySuperficial vein thrombosis (SVT) is a common disease, characterized by an inflammatory- thrombotic process in a superficial vein. Typical clinical findings are pain and a warm, tender, reddish cord along the vein. Until recently, no reliable epidemiological data were available. The incidence is estimated to be higher than that of deep-vein thrombosis (DVT) (1/1000). SVT shares many risk factors with DVT, but affects twice as many women than men and frequently occurs in varicose veins. Clinically, SVT extension is commonly underestimated, and patients may have asymptomatic DVT. Therefore, ultrasound assessment and exclusion of DVT is essential. Risk factors for concomitant DVT are recent hospitalization, immobilization, autoimmune disorders, age > 75 years, prior VTE, cancer and SVT in non-varicose veins. Even though most patients with isolated SVT (without concomitant DVT or PE) are commonly treated with anticoagulation for a median of 15 days, about 8% experience symptomatic thromboembolic complications within three months. Risk factors for occurrence of complications are male gender, history of VTE, cancer, SVT in a non-varicose vein or SVT involving the sapheno-femoral junction (SFJ). As evidence supporting treatment of isolated SVT was sparse and of poor quality, the large, randomized, double-blind, placebocontrolled CALISTO trial was initiated assessing the effect of fondaparinux on symptomatic outcomes in isolated SVT. This study showed that, compared with placebo, 2.5 mg fondaparinux given for 45 days reduced the risk of symptomatic thromboembolic complications by 85% without increasing bleeding. Based on CALISTO and other observational studies, evidence-based recommendations can be made for the majority of SVT patients. Further studies can now be performed in higher risk patients to address unresolved issues.

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Superficial vein thrombosis in non-varicose veins of the lower limbs and thrombophilia

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517690643 ◽

2017 ◽

Vol 33 (4) ◽

pp. 278-281 ◽

Cited By ~ 1

Author(s):

Gabriella Lucchi ◽

Salvino Bilancini ◽

Sandro Tucci ◽

Massimo Lucchi

Keyword(s):

Varicose Veins ◽

Factor V Leiden ◽

Protein S ◽

Lower Limbs ◽

Factor V ◽

Superficial Vein ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis ◽

High Prevalence ◽

Acquired Thrombophilia

Objectives Superficial vein thrombosis in non-varicose veins of the lower limbs is rather frequent and may be underestimated. This study aims to evaluate the prevalence of inherited or acquired thrombophilia in a sample of outpatients with the disease. Method An observational study was conducted on 73 consecutive superficial vein thrombosis patients tested for inherited or acquired thrombophilia. Results Sixty of 73 patients with superficial vein thrombosis completed the testing protocol, while 13 dropped out; 46 of 60 patients were found to have a thrombophilia (76.6%). The types detected were: factor V Leiden (31/60, i.e. 51.6%), prothrombin mutation (2/60, i.e. 3.3%), MTHFR mutation (23/60, i.e. 38.3%), antiphospholipid antibodies (5/60, i.e. 8.3%), protein C deficit (1/60, i.e. 1.6%), protein S deficit (1/60, i.e. 1.6%), and antithrombin deficit (0/60, i.e. 0%). Conclusions Among patients with superficial vein thrombosis in non-varicose veins, testing demonstrated a high prevalence of thrombophilia. The most common form proved to be factor V Leiden. As thrombophilia was found to be a major cause of superficial vein thrombosis in non-varicose veins, the authors recommend that patients with superficial vein thrombosis in non-varicose veins be investigated for thrombophilia.

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Superficial Vein Thrombosis of Lower Limbs: Influence of Factor V Leiden, Factor II G20210A and Overweight

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615180 ◽

1998 ◽

Vol 80 (08) ◽

pp. 239-241 ◽

Cited By ~ 37

Author(s):

Robert Wutschert ◽

Monica Heinzmann ◽

Thomas Perneger ◽

Guido Reber ◽

Henri Bounameaux ◽

...

Keyword(s):

Varicose Veins ◽

Factor V Leiden ◽

Lower Limbs ◽

Factor V ◽

Superficial Vein ◽

Vein Thrombosis ◽

Healthy Donors ◽

Factor Ii ◽

Superficial Vein Thrombosis ◽

Fv Leiden

SummarySuperficial vein thrombosis (SVT) has been reported in patients with thrombophilia. In the present unmatched case-control study, the two most common thrombophilic abnormalities (factor V Leiden and factor II G20210A) were searched for in 112 consecutive patients with SVT of lower limbs and in 180 healthy donors. FV Leiden was present in 16/112 (14.3%) SVT patients and 11/180 (6.1%) controls (odds ratio 2.51, 95% CI 1.04-6.24) and FII G20210A in 4/112 (3.6%) patients and 2/180 (1.1%) controls (OR 3.28, 95% CI 0.46-36.84). In addition, body mass index (BMI) ≥28 kg/m2 was also associated with SVT (OR 2.81, 95% CI 1.60-5.00). After adjustement for BMI ≥28 kg/m2, the association between FV Leiden and SVT remained strong though no longer statistically significant. Among patients with SVT, the presence of FV Leiden was independently associated with the absence of varicose veins (OR 4.62, 95% CI 1.25-18.0) and with a BMI ≥28 kg/m2 (OR 3.74, 95% CI 1.05-15.1). In conclusion, both FV Leiden and overweight seem to predispose to SVT, a finding that should be confirmed in larger studies.

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