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Ep 33 – Superficial venous thrombosis in primary care

In this episode, Kevin considers the diagnosis and management of superficial venous thrombosis. Lesley is a 64-year-old woman who presents to us with a sore, itchy right leg and no past medical history of note. On examination, she has a tender, hard, erythematous varicose vein extending from her thigh to ankle. What should we do next? Should we be worried about underlying deep vein thrombosis?

 

Key references discussed in the episode:

 

Key take-home messages from the episode:

  • Superficial venous thrombosis (SVT) is the preferred term to superficial thrombophlebitis because the underlying pathology is that of thrombus formation rather than inflammation or infection.
  • SVT shares risk factors with deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • If the SVT involves veins near the junction with the deep venous system, the risk of DVT and PE can reach nearly 20%.
  • D-dimer is of no value in differentiating SVT from DVT.
  • Consider referring all patients with clinical SVT of the lower limb for ultrasound scan.
    • Individuals with below-knee SVT without evidence of DVT can be managed in primary care with non-steroidal anti-inflammatory drugs and compression.
  • Individuals with SVT near the sapheno-femoral junction or sapheno-popliteal junction should be considered for surgical ligation or anticoagulation.
    • Also consider anticoagulation if the superficial thrombus is >5 cm in length.
  • Antibiotics have no role in the treatment of thrombophlebitis, except in clear cases of infection.

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