Abstract No. 716 Percutaneous microthrombectomy as an effective symptomatic treatment for uncomplicated superficial venous thrombophlebitis

Abstract

Percutaneous needle puncture and thrombus evacuation has been described classically as an adjunct measure to prevent post-sclerotherapy skin hyperpigmentation and was also anecdotally described as a measure of symptomatic relief from venous wall distention by the clot. We questioned the efficacy of this minimally invasive technique in a patient with uncomplicated focal superficial venous thrombosis (SVT). Ninety-eight consecutive patients (mean age, 48) with focal leg pain and fullness with documented venous insufficiency by Doppler ultrasound presented to an outpatient vein clinic between February 2006 and November 2011 were reviewed. Among these, 48 patients did not have a prior history of venous disease or treatment while 50 patients had recent venous interventions including sclerotherapy of saphenous tributaries (45) or endovenous laser therapy (5). Thirty-three patients (33.7%) were found to have SVT, while 4 patients had alternative diagnoses: soft tissue mass (3) and focal soft tissue infection (1). In the remainder, no clear diagnosis was established. Among 33 patients with SVT, twelve without prior vein treatment had focally dilated varicosities containing thrombus. Seven had SVT extending into a great saphenous vein, but at least 10 cm distal to saphenofemoral junction. Three had isolated single-segmental tributary SVT and two had multi-focal involvement within tributaries. Remaining 21 patients were found to have focal, less than 3 cm, tributary SVT without varicosities. One patient (3.1%) was placed on systemic low molecular weight heparin due to ascending extension of great saphenous SVT with no further improvement of pain. Thirty-one out of remaining 32 patients who underwent the needle/catheter microthrombectomy yielding immediate symptomatic relief (96.9%) after draining 0.2 to 4 ml of crankcase oil appearing thick fluid. 3 (9.4%) had recurrent pain and 17 (53.1%) complained of persistent focal hardness albeit less pain. No post-procedural complication was observed. Percutaneous needle microthrombectomy is an effective symptomatic treatment in uncomplicated SVT, which can be performed and repeated in an outpatient setting without significant risks.