Prevalence of deep vein thrombosis and pulmonary embolism in thrombophlebitis of the lower limbs: prospective study of 60 cases

DISSERTATION ABSTRACT

Prevalence of deep vein thrombosis and pulmonary embolism in thrombophlebitis of the lower limbs: prospective study of 60 cases

Marcone Lima Sobreira

PhD, Surgery, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Assistant physician, Course of Vascular and Endovascular Surgery, Department of Surgery and Orthopedics, UNESP, Botucatu, SP, Brazil, Specialist in Vascular Surgery, Angiography and Endovascular Surgery, SBACV/AMB, Specialist, Vascular Doppler, SBACV/CBR/AMB

^{Correspondence}

Background:Ascending superficial thrombophlebitis (ST) of lower limbs (LLs) is a common disease characterized by thrombosis of the superficial vein followed by inflammatory reaction of the venous wall and neighboring tissues. It may occur associated with a primary state of hypercoagulability, evident or developing systemic diseases (neoplasias, collagenosis, and hemopathies), and varices and as a complication caused by intravenous therapy. It may also be associated with deep venous thrombosis (DVT) and pulmonary embolism (PE) at high frequencies. Considering that the clinical diagnosis of DVT and PE have low sensibility and specificity and that there are no data in the national literature assessing the complication of ascending ST in terms of its transmission to the deep venous system causing PE, we suggested the present study, which was approved by the Research Ethics Committee.

Objectives:To investigate the prevalence of DVT and PE as complications of ascending ST of LLs in the great saphenous vein (GSV) or small saphenous vein (SSV), as well as the probable previous factors that could increase the risk of developing such complications.

Patients and methods:We consecutively investigated 60 patients with ascending ST in the GSV and SSV who were treated between 2000 and 2003. All patients underwent clinical evaluation, venous duplex scanning of the LLs in order to confirm the diagnosis of ST and investigation of DVT and pulmonary scintigraphy to investigate PE.

Results: In the 60 patients investigated, DVT was concomitant in 13 cases (21.67%) and PE was concomitant in 17 patients (28.33%). Eleven patients presented with a clinical picture suggestive of DVT, but in only eight of them (61.5%) this diagnosis was confirmed. Fourteen patients had a clinical picture suggestive of PE, and this diagnosis was confirmed only in six of them (35.30%). Those patients with associated DVT and/or PE were anticoagulated using heparin and antivitamin K. None of the previous symptoms assessed was predictive of DVT or PE (p > 0.05). However, the presence of varices reduced the patients's risk of having DVT (relative risk = 9.09; 95%CI: 1.75-50.00 and p = 0.023).

Conclusion:The prevalence of PE and DVT was high in the cases of ascending ST, which drew attention to the need of careful assessment of patients regarding these complications in order to make the therapeutic decision.

Keywords: Pulmonary embolism, prophylaxis, thrombophlebitis, deep venous thrombosis.

Manuscript received Jan 21 2009, accepted for publication Nov 10 2009.

No conflicts of interest declared concerning the publication of this article.

PhD dissertation written at Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil and presented on August 24, 2007.

Advisor: Winston Bonetti Yoshida.

Examiners: Guilherme Benjamin Brandão Pitta, Roberto Augusto Caffaro, José Maria Pereira De Godoy, Hamilton Almeida Rollo.

Publication Dates

• Publication in this collection
  01 Sept 2010
• Date of issue
  2010