A 58-year-old man develops a painful, tender, red indurated cord along the great saphenous vein of the right thigh. Doppler ultrasound confirms superficial thrombophlebitis extending to within 2 cm of the saphenofemoral junction, with the deep system patent. How should he be managed?
- A Topical NSAIDs and compression bandaging alone
- B Prophylactic dose low molecular weight heparin for four weeks
- C Therapeutic anticoagulation for at least four weeks, as extension towards the saphenofemoral junction carries a high risk of deep vein thrombosis ✓
- D Immediate high ligation and stripping of the great saphenous vein
Explanation
Superficial thrombophlebitis located within about 3 cm of the saphenofemoral junction behaves like a deep vein thrombosis because clot propagates into the common femoral vein, so guidelines recommend therapeutic anticoagulation for four weeks or longer. Simple measures such as topical NSAIDs, compression, and mobilisation are adequate only for superficial phlebitis remote from the junction. Prophylactic dosing under-treats this risk. Surgery is reserved for failure of medical therapy or septic thrombophlebitis, not uncomplicated near-junction disease, which eliminates the operative distractor.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.