Diagnostic and Surgical Treatment of the Thrombophlebitis in the Saphenofemoral Junction

Zusammenfassung

Ziel: Wir berichten in dieser retrospektiven Studie über die Diagnostik und chirurgische Therapie von 10 Patienten, die mit frei flottierenden vom oberflächlichen in das tiefe Beinvenensystem hineinreichenden Thromben in unserer Klinik behandelt wurden. Material und Methoden: Die Diagnose frei flottierender Thromben wurde mittels B-Mode und farbkodierter Duplex-Sonografie gestellt. Die chirurgische Entfernung der Thromben erfolgte als Notfalleingriff. Ergebnisse: 2 der Patienten wiesen entsprechende Thromben in beiden Beinen auf. 5 der 10 Patienten hatten bereits präoperativ eine Lungenembolie erlitten. Intra- und postoperativ kam es jedoch in keinem Fall zu einer Lungenembolie. Nach erfolgter Entfernung des thrombotischen Materials und einer perioperativen systemischen Heparinisierung konnten die Patienten, die präoperativ keine Lungenembolie erlitten hatten und keine Gerinnungsstörung aufwiesen, ohne weitere antikoagulatorische Therapie nach Hause entlassen werden. Schlussfolgerung: Patienten mit Thrombophlebitis des oberflächlichen Beinvenensystems sollten eine Ultraschall-Untersuchung bekommen. Liegen frei flottierende Thrombusanteile, die vom oberflächlichen in das tiefe Venensystem hineinreichen, vor, sollte eine sofortige chirurgische Entfernung dieser Thromben in adäquater chirurgischer Technik erfolgen.

Abstract

Purpose: This retrospective study reports on the diagnostic and surgical treatment of 10 patients with ascending thrombophlebitis in the proximal great saphenous vein with free-floating thrombi reaching into the common femoral vein. Materials and Methods: 10 patients were operated in our clinic for thrombophlebitis with free-floating thrombi in the saphenofemoral junction. Diagnosis of free-floating thrombi was made by B-mode and color-coded duplex ultrasound examination. Surgical thrombectomy was performed immediately. Results: No operative complications were observed, while 5 of 10 patients sustained preoperative pulmonary embolism. After successful thrombectomy and perioperative systemic heparinization, patients who had no PE and no thrombophilic disorders were discharged without any further anticoagulant therapy. Conclusion: The results of our retrospective study show that patients with an ascending thrombophlebitis should undergo ultrasound examination to detect free-floating thrombi reaching into the deep venous system. In case of free-floating thrombi, immediate surgical thrombectomy, which is safe and provides rapid recovery from symptoms, is indicated.

Key words

thrombophlebitis - color-coded duplex sonography - thrombectomy - vascular surgery

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