Superficial thrombophlebitis of lower limbs.

In the absence of malignancy, thrombophlebitis of the lower limb is invariably associated with pre-existent varicose veins. Not until pulmonary embolism was reported to occur in superficial phlebitis did the clinician introduce anticoagulants and/or surgery in the management of this condition. In an effort to reach an effective approach to this problem, 1,000 consecutive cases of varicose veins of the lower limbs were reviewed. Of these patients, 779 were admitted for elective vein ligation and stripping and 221 presented with thrombophlebitis. The latter group was subdivided into four categories according to the mode of management: (1) local heat and anti-inflammatory agents, 60 cases; (2) anticoagulants, 22 cases; (3) phlebotomy, high saphenous ligation and anticoagulation, 4 cases; and (4) ligation and stripping, 135 cases. In category 4 the saphenous is removed in a routine fashion together wih all its tributaries. All perforators are exposed, evacuated of thrombus when present, and ligated subfascially. Thrombi were encountered in one or more perforating veins in 10 patients, but no pulmonary embolism was observed in this group of patients. All instances of documented pulmonary embolism (10 cases) occurred in category 1 with one fatality. The incidence of pulmonary embolism in the elective group of ligation and stripping (without phlebitis) was 0.5%. The data indicate that the surgical approach is safe and preferable to the other modalities for several reasons: (1) It eliminates the varicosities and the phlebitic process simultaneously, (2) a single hospitalization is necessary (cost effectiveness), and (3) no anticoagulants are needed. If, for any reason, surgery cannot be undertaken, then anticoagulants should be employed in an effort to avoid thromboembolism.