Preliminary results of a nonoperative approach to saphenofemoral junction thrombophlebitis.

PURPOSE: A prospective, nonrandomized study was conducted to evaluate the efficacy of a nonoperative approach of anticoagulation therapy to manage saphenofemoral junction thrombophlebitis (SFJT).

METHODS: Over a 2-year period between January 1993 and January 1995, 20 consecutive patients with SFJT were entered into the study. They were hospitalized and given a full course of heparin. Duplex ultrasonography was performed before admission, both to establish the diagnosis and to evaluate the deep venous system. Two to 4 days after admission a follow-up scan was obtained to assess resolution of SFJT and to reexamine the deep venous system. Patients with SFJT alone and resolution of SFJT by duplex scanning were maintained on warfarin (Coumadin) for 6 weeks. Those with SFJT and deep venous thrombosis (DVT) were maintained on Coumadin for 6 months. Incidence of concurrent DVT and its location were noted. The efficacy of anticoagulation therapy was evaluated by measuring SFJT resolution, recurrent episodes of SFJT, and occurrence of pulmonary embolism (PE).

RESULTS: There was a 40% incidence (eight of 20 patients) of concurrent DVT with SFJT. Of the eight patients, four had unilateral DVT, two had bilateral DVT, and two had development of DVT with anticoagulation. DVT was contiguous with SFJT in five patients and noncontiguous in three patients. Of 13 duplex scans obtained at 2 to 8 months follow-up, seven demonstrated partial resolution of SFJT, five had complete resolution, and one did not demonstrate resolution. There were no episodes of PE, no recurrences, and no complications of anticoagulation at maximum follow-up of 14 months.

CONCLUSIONS: Anticoagulation therapy to manage SFJT was effective in achieving resolution, preventing recurrence and preventing PE within our follow-up period. There is a high incidence of DVT associated with SFJT that merits careful evaluation of the deep venous system during the course of management.