Phlebological emergencies

Abstract

Deep and superficial vein thromboses as well as variceal hemorrhages are emergencies. The risk of short- and long-term morbidity and mortality in vein thromboses is increased. Variceal hemorrhage harbors the risk of massive blood loss. Prompt and adequate therapy of these diseases is therefore essential. Our aim was to give an overview of these phlebological emergencies. Based on the current guidelines and supplemented by aselective literature search in PubMed, we summarize the most important aspects for clinical practice. In deep vein thrombosis, therapeutic anticoagulation and compression therapy are indicated for aduration of at least 3-6months. Ashorter duration is associated with aconsiderably increased recurrence rate. Basic measures in superficial vein thrombosis comprise mobilization, cooling, and compression. In case of tenderness on palpation, non-steroidal anti-inflammatory drugs are recommended. Indication for anticoagulation and its dose depends on length of the thrombus and distance of the proximal part of the thrombus towards the deep veins. Variceal hemorrhage is acomplication of advanced varicosis and can usually be handled with simple measures such as elevation of the extremity and compression. Prompt diagnosis and therapy is essential in superficial and deep vein thrombosis to prevent short-term complications such as pulmonary embolism and growth of the thrombus as well as long-term complications such as postthrombotic syndrome with secondary varicosis and chronic leg ulcer. After the occurrence of varicophlebitis or variceal hemorrhage, treatment of varicosis is indicated to prevent recurrences.