Chapter 150 - Superficial thrombophlebitis

Question 1

Association of SVT with DVT, asymptomatic PE and symptomatic PE

Answer 1

DVT 6-44%
asymp PE 20-33%
symp PE 2-13%

Question 2

Symptoms of SVT

Answer 2

1) tenderness along superficial vein
2) erythema
3) swelling
4) palpable cord

Question 3

Patients with SVT risk of developing DVT if varicose veins present

Answer 3

less likely to get DVT if varicose veins present

Question 4

Traumatic thrombophlebitis key points

Answer 4

1) illicit or iatrogenic drug therapy

2) direct endothelial injury

Question 5

Septic and suppurative thrombophlebitis key points

Answer 5

1) associated with IV cannula
2) septicemia
3) pus, fever, leukocytosis
4) organism: Staph aureus, pseudomonas, klebsiella, enterococcus, fusobacterium, candida

Treatment = remove foreign body and IV abx; rarely vein excision

Question 6

Migratory thrombophlebitis key points

Answer 6

1) Jadioux 1845
2) repeated thrombosis in superficial veins (mostly LE)
3) associated with carcinoma (Trousseau syndrome)
4) associated with vasculitis (Behcet, Buerger, PAN)

Question 7

Trousseau syndrome

Answer 7

Episodes of vessel inflammation due to blood clot appearing at different locations over time as a result of cancer

Question 8

Mondor disease

Answer 8

1) Thrombophlebitis of thoracoepigastric vein of breast and chest wall
2) breast cancer or hypercoagulable state most common
3) cord from lowere breast towards costal margin in anterolateral breast
4) self-limiting

also SVT of dorsal vein of penis after DVT, hernia operation or excessive intercourse
TX NSAID and dorsal penile vein resection

Question 9

SSV progression to DVT rate

Answer 9

16-65.6%

Question 10

Treatment of UESVT

Answer 10

remove catheter
conservative mgnt
+/- anticoagulation

Question 11

Risk of SVT after GSV strip, EVLT, RFA, foam

Answer 11

Strip 3.2%
EVLT 9.6%
RFA 13.7%
foam 4%

Question 12

Natural history of SVT

Answer 12

Inflammation 2-3 weeks
Recanalization or fibrosis 6-8 weeks
post-inflammatory hyperpigment months

Question 13

Benefit of compression in SVT

Answer 13

faster thrombus resolution

Question 14

STENOX trial key points

Answer 14

1) 427 patient RCT with SVT 5cm LE
2) enoxaparin, tenoxicam or placebo
3) day 12 DVT: 3.6% placebo, 0.9% enox, 2.1% tenoxicam
4) combined endpoint of SVT progression, recurrence and DVT favour use of enox

Question 15

Vesalio study key points

Answer 15

1) 164 patients with SVT of GSV to nadroparin prophylaxis or therapeutic
2) no significant difference

Question 16

CALISTO study key points

Answer 16

1) 3002 patients with acute SVT
2) fondaparinux 2.5 vs placebo
3) combined outcome VTE, death, extension of VT, symp SVT recurrence
4) 0.9% fondaparinox vs 5.9% placebo

Question 17

Rathbun study on SVT

Answer 17

1) 72 patient with UE or LE SVT
2) dalt vs ibuprofen
3) SVT extension or VTE
4) no significant difference at 3 months

Question 18

Cosmi study on SVT of GSV/SSV

Answer 18

1) 664 patients
2) different dose regimens of parnaparin
3) composite DVT, symptomatic PE and recurrence SVT in 33 days
4) 30 day intermediate dose better than prophylactic dose

Question 19

Cochrane review on NSAID in SVT

Answer 19

1) SVT extension and recurrence reduced by 67% with NSAID
2) no major bleed risk
3) no difference in VTE

Question 20

Surgical therapy in SVT

Answer 20

no clear evidence of benefit

Question 21

Upcoming studies on SVT

Answer 21

1) Europe rivaroxaban 10 vs fondaparinox

2) Canada rivaroxaban 10 vs placebo

Question 22

CHEST guidelines on SVT

Answer 22

1) SVT > 5cm, prophylactic dose of fondaparinux 2.5 mg for 45 days
2) LMWH is second choice