A 50-year-old woman with long-standing symptomatic great saphenous varicosities develops a painful, red, tender indurated cord along the varicosity in the thigh. There is no limb swelling and she is systemically well. What is the most appropriate initial management?

• A Systemic anticoagulation with therapeutic LMWH for three months
• B Immediate surgical excision of the affected vein segment
• C Compression stockings, NSAIDs, mobilisation, and reassessment ✓
• D Intravenous antibiotics for seven days

Explanation

Superficial thrombophlebitis of a varicose vein without extension towards the deep system is managed conservatively with compression, NSAIDs, heat, and mobilisation. Anticoagulation is reserved for progression within 5 cm of the saphenofemoral junction or extensive disease, per the CALISTO trial context. Antibiotics are not indicated as this is sterile inflammation unless there is overt septic phlebitis.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.