Varicose veins and their management

Sir

We read Professor Campbell's article on varicose veins with interest.
Of particular significance to Emergency Physicians was the small section
on the problems varicose veins can cause, especially superficial
thrombophlebitis.

Superficial thrombophlebitis poses a managerial quandry in the
Emergency Department due to the association with Deep Venous Thrombosis
(DVT), an association which Professor Campbell suggests is "remote".
Recent clinical experience in our department prompted us to examine this
association more closely.

Several studies have been undertaken. Bounameaux reported an
incidence of associated DVT of 5.6%. Decousus showed associated DVT or
pulmonary embolism in 13.8% of patients. Blumenberg showed symptomatic
pulmonary embolism developed in 1% (of 232 patients) with superficial
thrombophlebitis.

Given the common risk factors these conditions share, we are in the
process of re-evaluating our risk stratification for the management of
superficial thrombophlebitis. Our recent experience suggests the
condition isn't as straightforward as we first thought.

References:

1.Campbell B. Varicose veins and their management BMJ 2006; 333:
287-292

2.Bounameaux H, Reber-Wasem M. Superficial Thombophlebitis and Deep
Vein Thrombosis. Archives of Internal Medicine, 1997, 157: 1822-24

3.Decousus H. A pilot randomised double-blind comaprison of a low
molecular weight heparin, a nonsteroidal anti-inflammatory agent, and
placebo in the treatment of superficial vein thrombosis. Archives of
Internal Medicine, 2003, 163: 1657-63

4.Blumenberg RM, Barton E, Gelfand ML et al. Occult deep venous
thrombosis complicating superficial thrombophlebitis. Journal of Vascular
Surgery, 1998, 27: 338-43

Competing interests:
None declared