Classification and therapy of ascending varicophlebitis

Varicophlebitis is the most frequent and important acute complication of a varicosed long and/or short saphenous vein. In view of the controversial di scussion about the either conservative or surgical treatment, a clinically relevant classification of this syndrome appears useful: Stage I includes varicophlebitis without involvement of the respective junc tional valve - in the groin or at the knee - and deep veins. While in Stage II the proximal part of the thrombus has reached the respective junctional valves of the long or short sapheneous vein, in Stage III it has entered t he deep veins by means of these valves. In Stage IV the thrombus migrates v ia insufficient perforating veins into the deep system. Stages I and IV sho uld be treated conservatively first, removal of the varicous veins should b e performed after regression of the acute symptoms. Stages II and III shoul d be considered an indication for urgent surgery. The surgical strategy con sists of crossectomy, resection of the saphenous vein without stripping, ra dical excision of all varicous veins and ligature of insufficient perforati ng veins. In stage III the thrombectomy of the deep veins using the Fogarty -procedure must be carried out before any other measures are taken. In 1996 a total number of 40 limbs with ascending varicophlebitis (stage I = 16, s tage II = 19, stage III = 5) was observed. 10 extremities (stage I = 2, sta ge II = 5, stage III = 3) underwent surgical treatment. I patient developed a deep infection of the groin, the average stay in hospital was 9 days.