Does eradication of superficial vein incompetence after superficial vein thrombosis reduce the risk of recurrence and of deep vein thrombosis? A pilot study evaluating clinical practice in Örebro county, Sweden

Abstract

Background Elective eradication of superficial vein incompetence (SVI) is advocated after superficial vein thrombosis (SVT) to prevent venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and to prevent recurrent SVT. However, this practice currently lacks evidence and not all SVT patients are referred. Method Pilot study based on retrospective review of medical records for patients in Örebro county, Sweden; diagnosed with SVT during 2019. Patients in primary care without venous intervention were compared with patients from a vascular service treated with eradication for SVI, regarding prevalence of VTE and recurrent SVT during one-year follow-up. Results Out of 236 records reviewed, 97(41%) were included, 44 in the vascular care, and 53 in primary care. Erroneous diagnosis and coding were common causes for exclusion. The groups differed in ultrasound verified SVT 25(47.2%) and 35(79.5%) ( p = .001), LMWH treatment 13(24.5%) and 24(54.5%) ( p = .002), and history of prior SVT 19(35.8%) and 31(70.5%) ( p = .001). There was no difference in the incidence of VTE during follow-up, 1(1.9%) and 1(2.3%) ( p = 1.000), or recurrent SVT, 7(13.2%) and 6(13.6%), respectively ( p = .951). Conclusions This pilot study cannot confirm if elective eradication of SVI after SVT reduces the risk of VTE and recurrent SVT, however, the incidence of VTE was low in both groups. Limitations of the study are the small sample size and the lack of duplex ultrasound in all cases in both groups at diagnosis and at follow-up. Further prospective studies on homogenous populations are needed.

Modern ideas about the mechanisms of development of valvular insufficiency in chronic venous insufficiency

“…Ткачук (2019) зазначено, що тривалий рефлюкс сприяє морфологічним змінам венозної стінки [27]. Водночас за сучасними уявленнями навіть без рефлюксу венозний стаз викликає формування на поверхні ендотелію зон з низькою або нульовою силою зсуву (механічного впливу потоку кровіshear stress), що зі свого боку може призвести до пошкодження глікоколіксу, ендотеліальної дисфункції (ЕД) та структурних змін венозної стінки [1,11,20,28]. Згідно з даними вітчизняних та зарубіжних науковців, дисфункція ендотелію в пацієнтів з ВХВНК спочатку проявляється на мікросудинному рівні, тобто на рівні vasa vasorum середньої оболонки та адвентиції [35,36].…”

The choice of surgical correction method depending on the etiology of decompensated chronic venous insufficiency

“…The main reasons for trophic ulcers development in the patients with chronic venous insufficiency are the formation of persistent pathological vertical reflux in the deep and superficial venous system, as well as the presence of horizontal reflux at the level of the communicating and perforating veins of the lower third of the thigh and lower leg [1,2,3,4]. Orthostatic phlebostasis provokes progression of venous hemodynamic disorder and causes deterioration of microcirculation with impaired tissue trophism [5,6,7,8].…”