Isolated Great Saphenous Vein Thrombus Is Associated With High Rates of Propagation and Deep Venous Thrombosis Regardless of Treatment

Abstract

Isolated great saphenous vein thrombus (GSVT) is generally regarded as benign, and treatment is heterogeneous. Complications include thrombus propagation, deep venous thrombosis (DVT), and symptom persistence. We reviewed demographics, comorbidities, treatments, and outcomes of isolated GSVT at our institution. Records of patients who had lower extremity venous duplex (LEVD) imaging that demonstrated GSVT without concomitant DVT between July 2008 and June 2014 were reviewed. Demographic, medical, treatment, outcomes, and follow-up LEVD data were collected. During the study period, 42,129 LEVD examinations were performed. Of 80 limbs with GSVT, 9 with ipsilateral DVT and 4 post-laser ablation were excluded, leaving 67 limbs from 61 patients for analysis. Mean clinical follow-up was 761 days. Of these patients, 14.9% had a hypercoagulable state and 31.3% had prior GSVT or DVT; 22.4% of patients had malignant disease, 19.4% had recent surgery, and 3% had recent trauma; 58.2% were inpatients, who on average had more comorbidities than outpatients. Regarding treatment, 28.4% of patients were observed, 13.4% were treated with aspirin or nonsteroidal anti-inflammatory drugs, and 58.2% were anticoagulated. Following treatment, 38.8% of limbs remained symptomatic; 29 patients (43.3%) had repeated LEVD imaging at a median follow-up of 2 days. In this group, five (17.2%) had GSVT propagation and six (20.7%) developed new DVT. Two of the five patients who had GSVT propagation and five of the six who developed new DVT had been anticoagulated since their initial LEVD examination. At initial LEVD imaging, 13 patients (44.8%) had thrombus within 5 cm of the saphenofemoral junction (SFJ) and 16 (55.2%) had thrombus >5 cm from the SFJ. Of the patients with thrombus within 5 cm of the SFJ, there was no GSVT propagation and DVT occurred in 2 (15.3%). Of the patients with thrombus >5 cm from the SFJ, five (31.2%) had GSVT propagation and DVT occurred in four (25%). Isolated GSVT tends to affect patients with hypercoagulable states, prior clotting, malignant disease, or recent surgery. Treatment is heterogeneous and symptom persistence is common. Thrombus propagation and DVT are seen often in patients who receive follow-up duplex ultrasound examination, regardless of treatment. Proximity of clot to the SFJ is not associated with increased risk of propagation or DVT.