Background: Ascending saphenous phlebitis (ASPh) located in the proximal part of the long saphenous vein (LSV) may be a life-threatening condition. Crossectomy preventing propagation of the thrombus to the femoral vein is a valuable method in order to avoid pulmonary embolisation. The purpose of this study was to assess how often such a treatment, instead of preventing the danger of embolisation, may in fact create it.
Material and methods: 59 patients (22 men, 37 women), mean age 62 years (29–77) suffering from ASPh were analyzed. All Doppler duplex examinations were carried out by one investigator. In 4 cases, concomitant DVT of the same limb on crural level was found. A crossectomy was performed under local anaesthesia. If a thrombus was present in the deep veins (femoral, iliac), the patients were excluded from crossectomy.
Results: In 50 patients (85%) crossectomy was easy to perform because no thrombus was found in the most proximal part of LSV. An intraoperative evaluation revealed the presence of a thrombus at the sapheno-femoral junction in 9 cases (15%) but this had been recognized by previous doppler duplex in 5 cases (8%) only. In those patients, a thrombectomy at the saphenofemoral junction level and a crossectomy was defined as having a high risk of fragmentation during the procedure. A Fogarty catheter was routinely used. We did not notice any case of pulmonary embolisation perioperatvely.
Conclusion: A crossectomy in ascending saphenous phlebitis is hazardous in 15% of cases. A crossectomy is recommended as a safe and advisable method, in experienced hands of preventing pulmonary embolism.