46 yo f presents with LLE pain. On physical exam you note an area of redness on the lateral aspect of the thigh. Ultrasound demonstrates the following image. What is the appropriate management of the patient?
ANSWER: Anticoagulation
- This patient presents with a superficial venous thrombosis of >5cm in length
- Further evaluation of the SVT demonstrates extension into the common femoral vein (A deep vein)
- A superficial venous thrombosis (SVT) often presents with an area of redness, pain, warmth along the distribution of a superficial vein, often with a palpable cord.
- SVT is estimated to occur at a rate of 4 per 1000 per year in the US.1
- SVT’s have traditionally thought to be a benign disease, and treated with NSAIDS and warm compresses.2
- However, recent literature shows that the rate of concomitant DVT and PE can be as high as 25% and 5%, respectively. 3
- Current ACCP guidelines recommend treatment with fondaparinux or LMWH if the SVT is >5cm in length.4
REFERENCES
- Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J. Occult deep venous thrombosis complicating superficial thrombophlebitis. Journal of vascular surgery. 27(2):338-43. 1998. [pubmed]
- Cosmi B. Management of superficial vein thrombosis. Journal of thrombosis and haemostasis : JTH. 13(7):1175-83. 2015. [pubmed]
- Frappé P, Buchmuller-Cordier A, Bertoletti L. Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community-based study. Journal of thrombosis and haemostasis : JTH. 12(6):831-8. 2014. [pubmed]
- Kearon C, Akl EA, Comerota AJ. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 141(2 Suppl):e419S-94S. 2012. [pubmed]
