Comparative study between sapheno-femoral disconnection and low molecular weight heparin in management of above knee great saphenous vein superficial thrombophlebitis

Abstract EN

Aim : the aim of this work is to assess the safety and efficacy of saphenofemoral disconnection (SFD) in comparison to low molecular weight heparin (LMWH) in cases of above knee great saphenous superficial thrombophlebitis (STP) without involvement of the deep venous system.

Patients and Methods : 40 patients who completed the study period with mean age 37.5 years, were diagnosed as having above knee great saphenous STP without involvement of the deep venous system clinically and with duplex examination.

Blood tests for hypercoagulable state was done They were divided into two comparable groups each group was 20 patients : the first group was treated with SFD and the second group was treated with LMWH for 3 weeks (The first week : the recommended therapeutic dose, and prophylactic dose in the remaining two weeks) and following both groups of patients clinically and with duplex at one week, 1, 3, 6, months for complications, resolution, recurrence and occurrence DVT (Deep Vein Thrombosis).

Results : minor complications and resolution of the symptoms in the first week were equal in both groups but the rate of first month recurrence of STP is higher in surgically treated group (statistically non-significant).

Detection of DVT in follow up period is higher in the first 3 months of follow up in the surgically treated group (statistically non-significant) after that it was the same in both groups where no DVT was observed with either therapeutic method after 3 months to 6 months.

Neither pulmonary embolism (PE) nor mortality was recorded in this work.

DVT was treated medically.

No abnormal blood test for hypercagulable state was found before inclusion or during the study in any patient.

Conclusion : STP of the lower limb is easy to diagnose but till now there is no standard management because the etiology is not clear, it shares DVT in some etiological factors but not all factors.

Routine survey for thrombophilia is not recommended in the first attack of STP.

SFD was stressed as an emergency operation in cases of above knee great saphenous vein (CSV) STP without involvement of the deep venous system.

In this study it is found that no statistically significant difference between the groups of SFD and LMWH group in aspects of resolution, recurrence, and onset of DVT during the period of the study.