Duplex ultrasound in a 54-year-old woman identifies a 6 cm long occlusive thrombus occupying the great saphenous vein, with the cranial end of the thrombus lying 1.5 cm below the saphenofemoral junction. She has no cancer and no prior venous thrombosis. What is the appropriate management?
- A Immediate surgical ligation of the saphenofemoral junction
- B Compression stockings alone with review in 2 weeks
- C Therapeutic anticoagulation, managed like a deep vein thrombosis ✓
- D Aspirin 75 mg daily and mobilisation
Explanation
Superficial vein thrombosis within 3 cm of the saphenofemoral junction carries a substantial risk of extension across the junction into the common femoral vein and of coexisting or subsequent pulmonary embolism, so guidelines treat it as a deep vein thrombosis equivalent requiring therapeutic dose anticoagulation. Thrombosis confined further down the great saphenous trunk can be managed conservatively with compression, mobilisation and follow-up imaging. Prophylactic aspirin is insufficient, and surgery is reserved for failure of anticoagulation or contraindication to it.
Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.