PREVENTION OF DEEP VENOUS THROMBOSIS ASSOCIATED WITH SUPERFICIAL THROMBOPHLEBITIS OF THE LEG BY EARLY SAPHENOUS-VEIN LIGATION

Background: Thrombophlebitis of the superficial veins of the leg used to be regarded as a mild and uncomplicated disease, particularly in Ge rman speaking countries. Patients and Methods: In a retrospective clin ical study from 6/91 until 12/96 we followed the progress of all patie nts (n = 398) with thrombophlebitis of the vena saphena magna or parva . Parameters of interest were: the incidence of concommitant deep vein thrombosis and subsequent pulmonary embolism. All patients underwent colour duplex scanning, most of them repeatedly. In cases of proven as cending superficial thrombosis, or involvement of the saphenofemoral j unction, proximal saphenous vein ligation was performed (n = 56, 49 ve na saphena magna and 7 vena saphena parva). Among these groups, there were 10 patients with malignant disease (18%), ten with a history of t hrombosis (18%), another five comprised diabetes, recent major surgery and organ transplantation. Results: In 56 operations we found free-fl oating thrombi 6x (11%), 19x the sapheno-femoral junction was involved (33%), 24x the saphenous vein close to the junction (43%). Three pati ents develop deep vein thrombosis, despite surgery (0.75% of all and 5 % of the operated cases). 2 patients suffered from (non-lethal) pulmon ary embolism (0.5% and 3.5%, respectively). One embolism occured befor e vein ligation. Perioperative mobidity amounted to 8.5% (superficial wound infection, hematoma). Conclusion: Venous ligation is probably ef fective in reducing the rate of fatal pulmonary embolism.