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Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger's disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno–femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications. [ABSTRACT FROM AUTHOR]

Superficial venous thrombosis (SVT), an inflammatory–thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about 0.3 to 1.5 event per 1000 person-years, while the prevalence is approximately 3 to 11%, with different reports depending on the population studied. However, such pathology is not free of complications; indeed, it could extend to the deep circulation and embolize to pulmonary circulation. For this reason, an ultrasound examination is recommended to evaluate the extension of SVT and to exclude the involvement of deep circulation. Also, SVT may be costly, especially in the case of recurrence. Therefore, accurate management is necessary to prevent sequelae and costs related to the disease. This review aims to analyse the epidemiology of SVT, its complications, optimal medical treatment, and open questions with future perspectives. [ABSTRACT FROM AUTHOR]

BACKGROUND: Superficial venous thrombosis (SVT) is a blood clot that forms in superficial veins and may occur after surgery. Treatment typically consists of anticoagulation medication and palliative care. CASE PRESENTATION: A 20-year-old female basketball athlete presented to physical therapy (PT) after posterior labral repair. Examination revealed tenderness along the medial forearm, venous distension of the hand, and discomfort with wrist extension overpressure and resisted wrist flexion. The patient was referred by the physical therapist to the team physician, who ordered ultrasonography, which demonstrated SVT of the right basilic vein. The patient was placed on anticoagulation medication for 4 months. OUTCOME AND FOLLOW-UP: At 4 months after initial diagnosis, a computed tomography venogram revealed resolution of SVT. The patient continued with physical therapy throughout this period, with no adverse effects reported. DISCUSSION: Physical therapists play an important role in medical screening and referral of patients who present with potential vascular complications postsurgery. Physical therapists may also safely implement a plan of care in patients who develop medical complications after surgery. JOSPT Cases 2024;4(1):34-38. Epub 26 January 2024. doi:10.2519/josptcases.2024.12174 [ABSTRACT FROM AUTHOR]

Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger’s disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno–femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications.

Abstract Objectives Development of endovenous treatment and sclerotherapy technology makes it feasible for clinicians to treat varicose veins (VV) through day surgery (DS). Superficial venous thrombosis (SVT) of lower extremities is a common complication of VV. This study aimed to investigate whether the existence of SVT below knee affect the safety and efficacy of DS for VV patients. Methods This is a single-center retrospective study. Clinical data of 593 VV patients was retrospectively analyzed. Raw data were matched by the using of propensity score matching model. Operation time, technical failure, postoperative DVT, skin burns, saphenous nerve injury, subcutaneous induration, and bleeding were compared between the groups. Also, we compared VV recurrence, SVT formation, DVT events and the change of VCSS score with 12 months. Results Fifty-nine patients complicated with SVT below knee were matched with 118 patients had VV only. Perioperative and follow-up outcomes were similar in both groups except for the number of incisions (median = 6 [5, 7] VS median = 4 [4, 5], P

Objectives: Development of endovenous treatment and sclerotherapy technology makes it feasible for clinicians to treat varicose veins (VV) through day surgery (DS). Superficial venous thrombosis (SVT) of lower extremities is a common complication of VV. This study aimed to investigate whether the existence of SVT below knee affect the safety and efficacy of DS for VV patients. Methods: This is a single-center retrospective study. Clinical data of 593 VV patients was retrospectively analyzed. Raw data were matched by the using of propensity score matching model. Operation time, technical failure, postoperative DVT, skin burns, saphenous nerve injury, subcutaneous induration, and bleeding were compared between the groups. Also, we compared VV recurrence, SVT formation, DVT events and the change of VCSS score with 12 months. Results: Fifty-nine patients complicated with SVT below knee were matched with 118 patients had VV only. Perioperative and follow-up outcomes were similar in both groups except for the number of incisions (median = 6 [5, 7] VS median = 4 [4, 5], P < 0.001). Both groups experienced a great decrease in VCSS score. Conclusion: We systematically compared the clinical outcomes of DS in VV patients. Our results indicate DS is safe and effective for patients with VV, whether accompanied by SVT below the knee. Trial registration: The ClinicalTrials.gov identifier for this trial is NCT05380895 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Background: Isolated cortical venous thrombosis (ICVT) is an uncommon subtype of cerebral venous thrombosis that only affects the cortical veins on the cerebral convexities. Its clinical presentation is variable and may mimic other neurological conditions. Objective: We performed a systematic review using PRISMA guidelines of the available literature on ICVT. Methods: We reviewed articles in PubMed, SCOPUS, and EMBASE databases. We presented the evidence in sections in this manuscript, including epidemiology, clinical presentation, pathophysiology, radiological findings, and proposed treatment. Results: Of a total of 199 screened studies, we included 39 studies in the final analysis. Of those, 10 were systematic reviews, 11 were case reports, and 18 were case series related to ICVT. Seizures and headaches are the most common symptoms of ICVT. Magnetic resonance venography (MRV) is the diagnostic modality of choice. The standard of care in these cases is therapeutic anticoagulation with heparin and evaluation of an underlying hypercoagulable condition. A half of the patients might require antiepileptic drugs. Osmotherapy and craniectomy are rarely used, and mechanical thrombectomy does not seem to play a role in this patient's treatment. Conclusion: Isolated cortical venous thrombosis involves the cortical veins without involvement of the venous sinuses. Patients who usually present with focal seizures and headaches in the absence of a clear cause, the diagnosis of ICVT should be considered. MRV is the diagnostic modality of choice. Therapeutic anticoagulation is the standard of care. More research is required to clarify the role of novel anticoagulants and the duration of the therapy. [ABSTRACT FROM AUTHOR]

Background: Several disorders may result in forefoot pain. An uncommon cause of forefoot pain is subcutaneous plantar veins thrombosis (SCPVT) involving veins superficial to the plantar fascia.Purpose: To describe the ultrasound (US) appearance of SCPVT, which has been described only once in the radiological literature.Material and Methods: We performed a retrospective search of our PACS system from 2016 to 2020 to collect all cases of US-diagnosed SCPVT. We collected data on seven patients. Two radiologists analyzed the US images retrieved. All US examinations were performed with a multifrequency linear probe (frequencies in the range of 5-17 MHz).Results: A localized plantar nodule was palpable in 86% of patients. The subcutaneous thrombosed vein appeared in all patients as a round or ovoid nodule located in the subcutaneous tissues that corresponded in four patients (4/5, 80%) to the painful palpable nodule. The size was in the range of 4-7 mm (mean = 5.4 mm). The thrombosed vein presented a connection with adjacent patent veins, appeared enlarged, and almost filled with hypo-isoechoic material, and in two patients (2/7, 29%), a thin peripheral fluid component surrounding the thrombus was detectable. Continuous scanning demonstrated slow blood movements inside the peripheral component due to blood circulation. Failure to compress the lumen of the thrombosed vein during the real-time US was evident in all patients.Conclusion: SCPVT is a rare or underreported condition. Sonologists must know the US appearance of SCPVT to exclude other conditions and avoid unnecessary invasive studies. [ABSTRACT FROM AUTHOR]

Abstract Background Superficial venous thrombosis (SVT) is considered a benign thrombotic condition in most patients. However, it also can cause serious complications, such as clot progression to deep venous thrombosis (DVT) and pulmonary embolism (PE). Although most SVT patients are encountered in primary healthcare, studies on SVT nearly all were focused on patients seen in the hospital setting. This paper describes the protocol of the development and external validation of three prognostic prediction models for relevant clinical outcomes in SVT patients seen in primary care: (i) prolonged (painful) symptoms within 14 days since SVT diagnosis, (ii) for clot progression to DVT or PE within 45 days and (iii) for clot recurrence within 12 months. Methods Data will be used from four primary care routine healthcare registries from both the Netherlands and the UK; one UK registry will be used for the development of the prediction models and the remaining three will be used as external validation cohorts. The study population will consist of patients ≥18 years with a diagnosis of SVT. Selection of SVT cases will be based on a combination of ICPC/READ/Snowmed coding and free text clinical symptoms. Predictors considered are sex, age, body mass index, clinical SVT characteristics, and co-morbidities including (history of any) cardiovascular disease, diabetes, autoimmune disease, malignancy, thrombophilia, pregnancy or puerperium and presence of varicose veins. The prediction models will be developed using multivariable logistic regression analysis techniques for models i and ii, and for model iii, a Cox proportional hazards model will be used. They will be validated by internal-external cross-validation as well as external validation. Discussion There are currently no prediction models available for predicting the risk of serious complications for SVT patients presenting in primary care settings. We aim to develop and validate new prediction models that should help identify patients at highest risk for complications and to support clinical decision making for this understudied thrombo-embolic disorder. Challenges that we anticipate to encounter are mostly related to performing research in large, routine healthcare databases, such as patient selection, endpoint classification, data harmonisation, missing data and avoiding (predictor) measurement heterogeneity.

Acute hematogenous osteomyelitis is the most common cause of osteomyelitis in children. It requires early diagnosis and treatment to minimize the risk of sequela of growth disturbances and deformity. We present a case of an unusual presentation of osteomyelitis of the tibia with Superficial venous thrombosis in a 2½ year male child, which was 1st ever reported association. A high degree of clinical suspicion of venous thrombosis, especially in pediatrics osteomyelitis, is required, with high C-reactive protein and erythrocyte sedimentation rate levels, as the child presents insidiously.

Superficial venous thrombosis (SVT) of the upper and lower extremities has long been considered a relatively benign condition. But in recent years, the literature has suggested a benefit to anticoagulation in patients with certain thrombus characteristics (size, location, and distance to deep venous system) resulting in updates to clinical guidelines for the treatment of lower extremity SVT. Despite these now well‐established guidelines, there remains a paucity of guidance from national and international societies regarding the imaging of superficial veins when evaluating for venous thrombosis. We recommend potential strategies to close this gap. [ABSTRACT FROM AUTHOR]

Objectives: Superficial venous thrombosis (SVT) is the complications of varicose great saphenous veins (VGSVs), but its pathogenesis remains unclear. This study was designed to measure the changes in expression of matrix metalloproteinases (MMPs) and the tissue inhibitor of metalloproteinases (TIMPs) from SVT, VGSVs, and great saphenous veins (GSVs). Methods: In the venous walls of the three groups, the expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 proteins, protein-positive expression ratios, mRNA expression, and protein expression were determined by immunohistochemistry, polymerase chain reaction, and western blot. Results: The MMP-2, MMP-9, TIMP-1, and TIMP-2 protein-positive expression ratios, mRNA and protein expression in the SVT group were significantly higher than those in the VGSV and the GSV groups. The corresponding expression in the VGSV group were significantly higher than those in the GSV group. Conclusion: Disequilibrium of MMPs and TIMPs in SVT wall occurs due to underlying high hydrostatic pressure and inflammation. These results suggested that MMPs and TIMPs participate in the process of venous wall remodeling. [ABSTRACT FROM AUTHOR]

Introduction: The immunologic mechanisms between cellulitis and pseudocellulitis differ greatly, even though their clinical presentations may overlap. Areas covered: This article discusses cellulitis and common entities within the pseudocellulitis spectrum including acute lymphedema, superficial venous thrombosis, allergic contact dermatitis, lipodermatosclerosis, stasis dermatitis, erythema nodosum, cutaneous gout, and bursitis. The literature search was conducted from PubMed search engine between March and May 2021. Expert commentary: While immunologic differences in cellulitis and the various entities of pseudocellulitis are clear, there is a practice gap in applying these differences to the clinic and hospital setting. Further, existing studies are weakened by the lack of a gold-standard diagnosis in this disease category. Additional work is necessary in developing a gold-standard for the diagnosis and secondly, to project these immunologic differences as biomarkers to differentiate sterile inflammation from a potential life threatening bacterial or fungal infection. [ABSTRACT FROM AUTHOR]

Introduction Little is known about pathogenetic mechanisms of superficial venous thrombosis (SVT). We aimed to investigate the systemic inflammatory response in the acute phase of SVT, the time course of inflammatory markers and involvement of inflammation in resolution of thrombus in SVT. Material and methods The circulatory inflammatory parameters high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor α (TNF-α), interleukins 6, 8 and 10 (IL-6, IL-8, IL-10), and markers of fibrinolytic activity tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined in 68 patients with acute SVT of lower limbs, who were allocated to two groups, dalteparin 5000 IU once daily or 10 000 IU once daily. Recanalization of occluded veins was monitored by ultrasonography at regular intervals. Blood was drawn in the acute phase and after 12 weeks. Results In the acute phase a majority of the measured inflammatory markers were increased, while after 12 weeks most of them significantly dropped: hsCRP: 13.6 ±11.9 vs. 7.4 ±4.4, p < 0.001; IL-6: 3.8 ±3.1 vs. 2.6 ±1.9, p = 0.007. Significant changes in endogenic fibrinolytic parameters were also observed: t-PA activity decreased (0.81 ±0.35 vs. 0.68 ±0.34, p = 0.003), while PAI-1 levels increased (5.6 ±5.1 vs. 8.8 ±8.5, p < 0.001). Levels of inflammatory markers at inclusion and after 12 weeks were related to less effective thrombus resolution: CRP: r = 0.386, p = 0.001; IL-6: r = 0.384; TNF-α: r = 0.255, p = 0.037. Conclusions In the acute phase of SVT, most of the circulating inflammatory markers were increased and most of their levels decreased after 12 weeks. Levels of inflammatory markers were negatively correlated with the recanalization rate.

Introduction: Superficial venous thrombosis (SVT) is an underestimated and underreported disorder. Till date, there are no Indian epidemiological studies which have looked at the community or hospital prevalence rate of SVT. Patients and Methods: A retrospective cross-sectional study was done in the department of vascular surgery including all patients diagnosed and managed for SVT over the period of 2011–2018. All patients with deep vein thrombosis (DVT) were also screened for involvement of the superficial veins. The demographic data, imaging data, further management, and follow-up data were collected from the hospital records. The data were entered into EpiData software and Microsoft Excel (Microsoft Corporation, Redmond, Washington, USA), and data analysis was done in R (version 3.5.0) and Microsoft Excel. Results: There were a total of 119 patients between the ages of 16 and 76 years. There were 84 men and 35 women. The median age of the entire study population was 46 ± 14.18 years. Eighty-one cases had only SVT, whereas 38 patients had both SVT and DVT together. 78 (65.5%) patients were diagnosed based on clinical presentation, whereas 41 (34.5%) patients were diagnosed on imaging done for other causes. In the patients diagnosed on clinical findings, 54 (69.2%) patients underwent a duplex ultrasound to rule out DVT. 77 (64.7%) patients were related to underlying varicose veins. 19% of patients had previous thromboembolic disease. The most common involvement was of the superficial veins in the patients who were clinically diagnosed. 54 (45.4%) patients received anticoagulation. Six patients had systemic venous thromboembolic complications. Conclusions: Anticoagulation should be the mainstay of treatment of patients with SVT. Prospective studies on superficial vein thrombosis are needed to assess and promote awareness of this condition in light of the current understanding of this potentially dangerous condition.

Acute hematogenous osteomyelitis is the most common cause of osteomyelitis in children. It requires early diagnosis and treatment to minimize the risk of sequela of growth disturbances and deformity. We present a case of an unusual presentation of osteomyelitis of the tibia with Superficial venous thrombosis in a 2½ year male child, which was 1st ever reported association. A high degree of clinical suspicion of venous thrombosis, especially in pediatrics osteomyelitis, is required, with high C-reactive protein and erythrocyte sedimentation rate levels, as the child presents insidiously. [ABSTRACT FROM AUTHOR]

Objective: To present the clinical case of a patient with an upper extremity superficial venous thrombosis (SVT), and to highlight the importance for clinicians working in musculoskeletal care settings, to considered non-musculoskeletal causes for their patients' presentations. Clinical Features: A 31-year-old male presented to an academic chiropractic clinic with progressive left sided tension over the medial arm, extending to the anterior aspect of his proximal forearm. Intervention and Outcome: The patient was initially diagnosed with possible biceps/brachialis muscular strain and peripheral entrapment of the median nerve. A course of treatment involving soft tissue therapy was initiated. Unfortunately, the patient's symptoms worsened, and on further evaluation, near full occlusion and phlebitis of the left cephalic vein was discovered. Symptoms dissipated over the next few days with conservative medicinal efforts. Summary: Although not often viewed as a serious condition, or factored in the differential diagnoses of musculoskeletal practitioners, to not consider SVT as a cause of a patient's symptoms may lead to a protracted clinical course and increased discomfort for the patient, and in rare cases, more serious consequences. [ABSTRACT FROM AUTHOR]

Superficial venous thrombosis of the lower extremity is a common medical condition worldwide. Most of its epidemiologic data have come from the Western hemisphere suggesting female predominance and a high risk of venous thromboembolism. Initial diagnosis is still based on clinical suspicion and physical findings, but duplex ultrasound is often required to rule out concomitant deep venous thrombosis. Management options, including surgical and medical means, have been attempted with inconsistent result. In the last decade, clinical trials using anticoagulants such as low molecular weight heparin and new oral anti-Xa anticoagulants have demonstrated beneficial effects. Currently, oral nonsteroidal anti-inflammatories with or without compression are still the predominant initial treatment despite the proven clinical efficacy of oral anticoagulation in lowering thrombotic risk and symptom relief. In this review, most of the studies analyzed are after the year 2010 through PubMed index search and thus making it a contemporary update.

Introduction: Little is known about pathogenetic mechanisms of superficial venous thrombosis (SVT). We aimed to investigate the systemic inflammatory response in the acute phase of SVT, the time course of inflammatory markers and involvement of inflammation in resolution of thrombus in SVT.Material and Methods: The circulatory inflammatory parameters high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor α (TNF-α), interleukins 6, 8 and 10 (IL-6, IL-8, IL-10), and markers of fibrinolytic activity tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined in 68 patients with acute SVT of lower limbs, who were allocated to two groups, dalteparin 5000 IU once daily or 10 000 IU once daily. Recanalization of occluded veins was monitored by ultrasonography at regular intervals. Blood was drawn in the acute phase and after 12 weeks.Results: In the acute phase a majority of the measured inflammatory markers were increased, while after 12 weeks most of them significantly dropped: hsCRP: 13.6 ±11.9 vs. 7.4 ±4.4, p < 0.001; IL-6: 3.8 ±3.1 vs. 2.6 ±1.9, p = 0.007. Significant changes in endogenic fibrinolytic parameters were also observed: t-PA activity decreased (0.81 ±0.35 vs. 0.68 ±0.34, p = 0.003), while PAI-1 levels increased (5.6 ±5.1 vs. 8.8 ±8.5, p < 0.001). Levels of inflammatory markers at inclusion and after 12 weeks were related to less effective thrombus resolution: CRP: r = 0.386, p = 0.001; IL-6: r = 0.384; TNF-α: r = 0.255, p = 0.037.Conclusions: In the acute phase of SVT, most of the circulating inflammatory markers were increased and most of their levels decreased after 12 weeks. Levels of inflammatory markers were negatively correlated with the recanalization rate. [ABSTRACT FROM AUTHOR]

Abstract Background Cancer patients who develop a deep-vein thrombosis (DVT) or a pulmonary embolism (PE) are at higher risk of death than similar cancer patients who do not develop DVT or PE. The impact of isolated superficial venous thrombosis (SVT) (i.e. without DVT or PE) on the prognosis of cancer patients is unknown. Methods Data from the OPTIMEV, multicentre, observational study, to compare at 3 years the incidences of death, DVT-PE recurrence and bleeding of cancer patients with objectively confirmed SVT vs. cancer patients with DVT (matched 1:2 on age, sex, cancer stage) and vs. patients with SVT without cancer (matched 1:3 on age and sex). Results Cancer patients with SVT (n = 34) had a high risk of death (23.2%patient-year(PY)), that was similar to that of cancer patients with DVT (aHR = 1.0[0.6–1.9]) and higher to that of SVT patients without cancer (aHR = 9.0[3.5–23.1]). Cancer patients with SVT received anticoagulants for a median duration of 45 days and had a high risk of DVT-PE recurrence (6.0%PY), similar to that of cancer patients with DVT (adjusted cause-specific HR (aCHR) = 1.5[0.4–5.8]) and higher to that of SVT patients without cancer (aCHR = 2.9[0.7–11.9]). In our population, venous thrombosis on varicose veins was associated with a lower risk of death (aHR = 0.6[0.3–1.0]) and DVT-PE recurrence (aCHR = 0.6[0.2–1.7]). Conclusion Our results suggest that cancer patients with SVT have a poor prognosis, similar to that of patients with cancer-related DVT. The high rate of DVT-PE recurrence suggests that such patients may need longer duration of anticoagulant treatment. Highlights • Cancer patients who develop VTE have a poorer prognosis than those who don't. • Long-term prognosis of cancer patients who develop SVT is unknown • Risk of death appears similar between cancer patients with SVT vs. DVT • Risk of death is twice lower in cancer patients with thrombosis in varicose veins. [ABSTRACT FROM AUTHOR]

Maria E Litzendorf, Bhagwan SatianiHeart and Vascular Center and Division of Vascular Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USAAbstract: Treatment of superficial venous thrombosis (SVT) has recently shifted as increasing evidence suggests a higher than initially recognized rate of recurrence as well as concomitant deep venous thrombosis. Traditional therapies aimed at symptom control and disruption of the saphenofemoral junction are being called into question. The incidence of deep venous thrombosis has been reported to be 6%–40%, with symptomatic pulmonary embolism occurring in 2%–13% of patients. Asymptomatic pulmonary embolism is said to occur in up to one third of patients with SVT based on lung scans. The role of anticoagulation, including newer agents, is being elucidated, and surgical disruption of the saphenofemoral junction, while still an option for specific cases, is less frequently used as first-line treatment. The individual risk factors, including history of prior episodes of SVT, the presence of varicosities, and provoking factors including malignancy and hypercoagulable disorders, must all be considered to individualize the treatment plan. Given the potential morbidity of untreated SVT, prompt recognition and understanding of the pathophysiology and sequelae are paramount for clinicians treating patients with this disease. A personalized treatment plan must be devised for individual patients because the natural history varies by risk factor, presence or absence of DVT, and extent of involvement.Keywords: superficial venous thrombosis, progression, treatment

The physiologic changes in pregnancy predispose the pregnant patient to a variety of potential cardiovascular complications. In this article, we discuss the major cardiovascular disorders of pregnancy and their management, highlight specific diagnostic challenges, and discuss new developments in the field. Topics covered in this article include venous thromboembolism, acute myocardial infarction, peripartum cardiomyopathy, and aortic dissection., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Superficial venous disease, which includes superficial venous thrombosis (SVT) and varicose veins, may be associated with a higher risk of venous thromboembolism (VTE). Use of combined hormonal contraceptives (CHCs) has been associated with an increased risk of VTE compared with nonuse. Little is known about whether use of CHCs by women with superficial venous disease may further elevate the risk of VTE.Objectives: To investigate evidence regarding risk of VTE in women with SVT or varicose veins who use CHCs compared with non-CHC users.Methods: We searched the PubMed database for all English-language articles published from database inception through September 2014. We included primary research studies that examined women with SVT or varicose veins who used CHCs compared to women with these conditions who did not use CHCs. Outcomes of interest included VTE (among women with SVT or varicose veins) and SVT (for those with varicose veins).Results: Two studies were identified that met inclusion criteria. One fair-quality case-control study reported an odds ratio (OR) for VTE of 43.0 (95% confidence interval [CI] 15.5-119.3) among women with SVT using oral contraceptives (OCs) compared with nonusers without SVT. The OR for VTE was also increased for women with SVT not using OCs (OR 5.1; 95% CI 2.8-9.5) and for women without SVT using OCs (OR 4.0; 95% CI 3.3-4.7), compared with nonusers without SVT. One fair-quality cohort study demonstrated that women with varicose veins had an increased rate of VTE with use of OCs (1.85 per 1000 women-years [WY]), compared with users without varicose veins (0.84 per 1000 WY), nonusers with varicose veins (0.31 per 1000 WY) and nonusers without varicose veins (0.19 per 1000 WY). This study also demonstrated that women with varicose veins had an increased rate of SVT with use of OCs (10.63 per 1000 WY), compared with nonusers with varicose veins (7.59 per 1000 WY), users without varicose veins (1.89 per 1000 WY) and nonusers without varicose veins (0.77 per 1000 WY).Conclusion: Two studies suggest increased risk of VTE among OC users with superficial venous disease; however, no definitive conclusions can be made due to the limited number of studies and limitations in study quality. Theoretical concerns need to be clarified with further research on whether the risk of significant sequelae from superficial venous disease among CHC users is related to clinical severity of disease and underlying factors. [ABSTRACT FROM AUTHOR]

The article discusses superficial vein thrombosis (SVT) along with information on the signs and symptoms, diagnosis, treatment and risk for SVT. Topics discussed include cause of SVT when a blood clot forms in one of the surface veins on the body which lead to pain, redness, and swelling at the affected vein; diagnosis of the disease with ultrasound and physical examination; and treatment of the disease with anti-inflammatory medications such as ibuprofen or diclofenac.

Objective/Background Leg compression is considered basic treatment for superficial vein thrombosis (SVT), although scientific proof for its efficacy is lacking. The aim of the study was to evaluate the therapeutic effect of compression stockings on isolated SVT of the legs. Methods This was a single-center randomized controlled trial. Eighty patients with isolated SVT of the legs were instructed to wear compression stockings (23–32 mmHg) (CG) or no compression (NCG) for 3 weeks. All patients received low molecular weight heparin (LMWH) at prophylactic dosage. Non-steroidal anti-inflammatory drugs (NSAIDs) were allowed. The primary outcome variable was the reduction of pain as assessed by a visual analog scale (VAS) and the Lowenberg test. Secondary outcomes were the consumption of analgesics, thrombus length, skin erythema, D-dimer, and quality of life (QoL). Results Seventy-three patients completed the study. Clinical symptoms and QoL significantly improved from baseline to day 21 in both groups ( p < .001 for VAS, Lowenberg test, thrombus length, and erythema; p < .006 for QoL), and consumption of analgesics and D-dimer significantly decreased ( p < .001). There was no significant difference between the groups for all tested variables. At day 7, patients in the CG revealed a significantly faster thrombus regression ( p = .02). Conclusion Adding compression stockings for 3 weeks to LMWH and NSAIDs does not bring significant additional benefit in the treatment of isolated SVT. When worn for 1 week, compression stockings stimulate significantly faster thrombus regression. [ABSTRACT FROM AUTHOR]

Hypercoagulable states (HS) are inherited or acquired conditions that predispose an individual to venous and/or arterial thrombosis. The dermatologist can play a vital role in diagnosing a patient's HS by recognizing the associated cutaneous manifestations, such as purpura, purpura fulminans, livedo reticularis, livedo vasculopathy (atrophie blanche), anetoderma, chronic venous ulcers, and superficial venous thrombosis. The cutaneous manifestations of HS are generally nonspecific, but identification of an abnormal finding can warrant a further workup for an underlying thrombophilic disorder. This review will focus on the basic science of hemostasis, the evaluation of HS, the skin manifestations associated with hypercoagulability, and the use of antiplatelet and anticoagulant therapy in dermatology. [Copyright &y& Elsevier]

Objectives: Retrospective case–control study to determine the failure and endovenous heat-induced thrombosis (EHIT) rates of endovenous ablation (EVA) in patients with a history of superficial venous thrombosis (SVT). Methods: Study and control groups each consisted of 73 patients with or without the history of SVT, who underwent EVA between June 2010 and July 2012. All patients were followed with venous duplex ultrasound. Procedural failure and EHIT rates were considered primary outcomes. Results: There was no difference in EHIT or failure rates between study and control groups (P ¼ 1.00). There was no difference in EHIT or failure rates between patients with and without the history of venous thromboembolism (VTE), with and without the history of VTE and/or SVT, with and without the history of thrombophilia, and on and off anticoagulation for either group or the combined study population. For the combined study population, failure rate was higher in patients with a history of VTE. Conclusions: Although EVA seems to be safe and effective in patients with a history of SVT, vein access in this patient group might require multiple attempts. [ABSTRACT FROM AUTHOR]

Paradoxical embolism concerns the state when a venous thrombus gets into the arterial system through an intracardiac defect between the left and right part of heart causing stroke, visceral artery occlusion or acute limb ischemia. The purpose of this report is to present the case of paradoxical and pulmonary embolism as the first manifestation of patent foramen ovale in which the source of embolic material originates from the superficial venous system. In all arterial embolism events the possibility of the occurrence of paradoxical embolism should be considered. In searching for the source of a thrombus, diagnostic ultrasonography of the deep and superficial venous system is needed, as well as echocardiography. [ABSTRACT FROM AUTHOR]

Résumé Introduction La maladie de Mondor est une thrombophlébite superficielle rare, touchant historiquement le système veineux thoracique de la femme. Elle peut toutefois s’exprimer chez les deux sexes et intéresser toute la surface cutanée. Observation Nous rapportons l’observation d’un homme de 40 ans, diabétique de type 1, souffrant d’une thrombose de la veine dorsale superficielle de la verge qu’il traitait comme une mycose. Un traitement anti-inflammatoire non stéroïdien complété par une héparine de bas poids moléculaire permettait une évolution favorable en 2 semaines. Conclusion L’étiopathogénie et le traitement de la maladie de Mondor sont encore incomplètement dominés. Certains facteurs prédisposants ont été toutefois soulignés dans la littérature, auxquels il nous paraîtrait intéressant d’intégrer le terrain diabétique, susceptible par ses fréquentes problématiques pelviennes, d’être un irritant inflammatoire veineux local. Introduction Mondor's disease is a rare superficial thrombophlebitis, historically involving the thoracic venous system of women. However, it can occur in both gender and all over the skin. Case report We report a 40-year-old man with type one diabetes who presented with a thrombosis of the superficial dorsal vein of the penis that he treated as a fungal infection. Treatment with non-steroidal anti-inflammatory drugs and low molecular weight heparin contributed to a favorable outcome in 2 weeks. Conclusion Pathogenesis and treatment of Mondor's disease remain incompletely dominated. Some predisposing factors have been highlighted in the literature. It might be interesting to add diabetes, due to its frequent pelvic problems leading to a potential venous inflammatory trigger. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Superficial venous thrombosis (SVT) has been considered for a long time a limited clinical condition with a low importance, but this approach has changed in recent years, when several studies demonstrated spreading to deep veins occurring from 7.3 to 44%, with high prevalence of pulmonary embolism. Materials and methods: To evaluate the prevalence of genetic risk factors for VTE in patients suffering from SVT on both normal and varicose vein, and to understand their role on spreading to deep veins, we studied 107 patients with SVT, without other risk factors. Ultrasound examination was performed, and the presence of FV Leiden, Prothrombin G20210A mutation, and MTHFR C677T mutation was researched. Results: In the patients where SVT occurred in normal veins, the presence of FV Leiden was 26.3% of the non-spreading and 60% of the spreading to deep veins SVT; Prothrombin mutation was found in 7.9% of the former case and in 20% of the latter; MTHFR C677T mutation was found respectively in 23.7% and 40%. In the patients with SVT on varicose veins, the presence of these factors was less evident (6.7%, 4.4% and 6.7% respectively), but their prevalence was considerably higher (35.7%, 7.4% and 21.4% respectively) in SVT spreading to deep veins than in non-spreading. Conclusions: Our data demonstrate the high prevalence of these mutations, especially FV Leiden and associations, in patients with SVT on normal veins and their role in the progression to deep vein system. [Copyright &y& Elsevier]

Abstract: Background: Routine thrombophilia testing is controversial because of the low yield of positive tests, costs involved, and debate about the clinical usefulness of the data obtained from testing. Laboratory investigations are rarely done for those with superficial venous thrombosis (SVT) or isolated calf vein thrombosis (CVT) which are often not treated with anticoagulants. Objective: To identify the incidence of markers of thrombophilia in patients with deep vein thrombosis (DVT), SVT, isolated CVT or a history of thrombosis in a referral practice. Methods: One hundred and sixty-six patients were referred to our thrombosis unit for consultation, including patients with SVT, DVT, and preoperative patients with a previous history of SVT or DVT. Patients underwent thrombophilia screening and patients with a diagnosis of SVT or DVT were confirmed by bilateral duplex ultrasonography of all lower limb veins. Thrombophilia testing included factor V Leiden (FVL), prothrombin 20210A mutation (P2), methylene tetrahydrofolate reductase deficiency (MTHFR), fasting serum homocysteine (HC), lupus anticoagulant (LA), anticardiolipin antibodies (ACA), antithrombin deficiency (AT), protein S deficiency (PS), and protein C deficiency (PC). Results: The incidence of any significant abnormality in patients with DVT was 27/44 (61%; 95% Confidence interval [CI], 47–76%) and 10 of these patients were positive for FVL (23%; 95% CI, 10–35%). Twelve patients with isolated CVT were seen and five had at least one abnormality (42%; 95% CI, 14–70%) including one with FVL (8%; 95% CI, 0–24%). Thirty-nine patients with isolated SVT were seen including 14 with at least one abnormality (36%; 95% CI, 21–51%) and five of these patients with SVT had FVL (13%; 95% CI, 2–23%). Nine patients with recurrent DVT were seen and five of these had at least one abnormal test (56%; 95% CI, 23–88%). Finally, 18 of the 166 patients had more than one abnormality (11%; 95% CI, 6–16%). Conclusion: The presence of one or more markers of thrombophilia was significantly higher in this patient population compared to reports from other centres. This study identified 18/166 (10.8%; 95% CI, 6–16%) with more than one defect where life-long anticoagulation might be considered. The results in this subset of patients as well as the serious defects found in some patients with provoked DVT, isolated CVT or isolated SVT demonstrate the value of this screening program to both these patients and their blood relatives. On the other hand, this is a small series from a referral practice where the incidence of these defects is greater than one would expect in the general population. These studies are preliminary and it is not recommended that all VTE patients should be screened on the basis of the current report. [Copyright &y& Elsevier]