© Schattauer 2013 Phlebologie 4/2013 1 Thrombosis of the small saphenous vein E. Mendoza Venenpraxis, Wunstorf Keywords Small saphenous vein, thrombosis, leg pain, duplex ultrasonography Summary Thromboses of the truncal veins are usually very painful. The short saphenous vein, which passes directly over the sural muscles, is par- ticularly painful when walking. These throm- boses can either occur spontaneously or be caused by cramped posture (squatting), im- mobilisation of the leg, or after calf injuries. Thrombosis of the superficial leg veins is par- ticularly dangerous because these usually communicate with the deep veins of the leg via a wide opening which permits the throm- bus to grow into the deep vein of the leg. The differential diagnosis must include a pos- sible complication of treatment of the short saphenous vein such as sclerotherapy or en- doluminal treatment (e.g. Venefit or LASER). Thromboses of superficial leg veins are clas- sically called phlebitis. Use of the term „thrombosis of the superficial vein of the leg“ has been suggested instead of phlebitis to prevent confusion with infectious events. Schlüsselwörter Vena saphena parva, Thrombose, Bein- schmerz, Duplexsonographie Zusammenfassung Thrombosen der Stammvenen sind meist sehr schmerzhaft. Besonders beim Laufen schmerzt die Thrombose der V. saphena par- va, die direkt auf der Wadenmuskulatur auf- liegend verläuft. Diese Thrombosen können spontan auftreten oder motiviert nach Zwangshaltungen (Hocke), Beinruhigstellung oder nach Wadenverletzungen. Von einer Thrombose in oberflächlichen Beinvenen geht eine besondere Gefährdung aus, da die- se meist über eine breite Mündung mit der tiefen Beinvene verbunden sind und hierüber ein Einwachsen des Thrombus in die tiefe Beinvene möglich ist. Differenzialdiagnostisch muss eine Folge nach Behandlung der V. saphena parva erwogen wer- den, wie die Sklerotherapie oder endolumina- len Behandlungen (z.B. Venefit oder LASER). Thrombosen oberflächlicher Beinvenen wur- den klassisch Phlebitis genannt. Um Ver- wechslungen mit infektiösen Vorgängen zu vermeiden, wurde die Verwendung des Be- griffs „Thrombose der oberflächlichen Bein- vene“ statt Phlebitis vorgeschlagen. Correspondence to Dr. Erika Mendoza Venenpraxis Wunstorf Speckenstr. 10, 31515 Wunstorf Thrombose der Vena saphena parva Phlebologie 2013;42: 219–222 DOI: 10.12687/phleb2153-4-2013 Received: June 15,2013 Accepted: June 17,2013 Young Phlebology Case Report A 50-year-old male was referred by his gen- eral practitioner to rule out a thrombosis. History The general history is unremarkable, he is taking no medication, and is otherwise healthy. Previous phlebological findings: Dis- crete reflux in left short saphenous vein, to date no treatment indicated, symptom- free, refilling time after muscle pump over 48 seconds, no skin changes. The acute history reveals: Patient had renovated the parquet flooring in his apart- ment at the weekend. Since Sunday even- ing he had had progressive pain in the calf that had become increasingly worse. He had been wearing compression since the evening before, which gave him some re- lief. Findings Calf relatively unremarkable on inspection, pronounced pain on pressure along the dorsal midline. Ultrasonography Complete occlusion of the small sa- phenous vein extending into the Giacomini vein, the deep veins of the leg are not af- fected (▶ Fig. 1, ▶ Fig. 2, ▶ Fig. 3) (2). Treatment The only medication that is licensed for treatment of superficial thromboses is Fon- daparinux at a dose of 2.5 mg for 6 weeks. However, the guideline recommends thera- peutic anticoagulation if the clot extends until next of the deep veins of the leg. Therefore, Fondaparinux was injected at a therapeutic dosage (7.5 mg for a patient weighing 85 mg) for the first 20 days until the first follow-up ultrasonography. He was also to wear class II compression (a knee sock) during the day and take 400 mg ibu- profen up to three times daily after meals as required. Follow-up after 3 weeks The patient was symptom-free on com- pression and therapeutic anticoagulation. Slight pain on pressure of the calf. Ultraso- nography showed the picture of thrombus to be unchanged. Prescribed treatment was to continue the compression and switch to Arixtra 2.5 mg for a further 3 weeks. Focus on duplex ultrasonography