A 45-year-old man presents with a painful, tender, cord-like induration along the medial thigh with surrounding erythema. There is no limb swelling and duplex ultrasound shows thrombus confined to the great saphenous vein within 2 cm of the saphenofemoral junction. Which management is most appropriate?

• A Warm compresses and non-steroidal anti-inflammatory drugs alone
• B Systemic corticosteroids
• C Immediate high ligation and stripping of the great saphenous vein
• D Therapeutic dose low molecular weight heparin for at least 4 weeks ✓

Explanation

Superficial thrombophlebitis within 3 cm of the saphenofemoral junction behaves like a deep vein thrombosis because of the risk of propagation into the common femoral vein, so therapeutic anticoagulation with low molecular weight heparin for around 4 weeks is recommended. Conservative treatment alone is reserved for uncomplicated superficial phlebitis remote from the junction, surgery is not first line acutely, and steroids have no role. Thrombus proximity to the junction is the fact that decides management.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.