One doctor said to do nothing, may be more risky. Another said to ligate at groin and ankle and leave vein in. Why such differing opinions? What can I expect I have vein ligated?
I strongly suggest a high ligation and at the same time, an endovenous laser ablation of the great saphenous vein from the groin to the knee. The clot may be removed, treated, or destroyed during the ablation, and the rest of the vein will not cause another occasion once ablated. The ligation prevents any possible embolus of the clot that could be dangerous due to its size.
Published on Jul 11, 2012
Your question raises a few questions. Have you had vein treatment? If so, when and what type? Your answers to these questions would allow me to provide more advice. Also, your history would provide more information. I am not sure why the range in advice given you by two doctors.
Published on Jul 11, 2012
Having that greater saphenous vein ligated would require surgery which, in reality, is not a typical way of treating that vein because of the position of the vein and the size, unless it was extremely superficial and small. Since the clot is in a superficial vein, there is not a whole lot of health risk involved and many physicians would recommend taking some aspirin and letting the body take care of itself. If the vein is not superficial enough, then ligating it would require that full surgery along with recovery. I would recommend consulting with an interventional radiologist.
Published on Jul 11, 2012
Warm compression and aspirin as this represents phlebitis - inflammation of the superficial veins. Also, you should see a vascular specialist for thorough evaluation of your deep veins.
Published on Jul 11, 2012
The treatment of superficial venous thrombosis is controversial, and hinges on how close to the common femoral vein junction the clot is, whether it is stationary and firmly adhered to the vein wall or if it is extending closer daily to the junction, or loosely adhered to the vein wall and at risk for dislodgement. Once all that is considered, other considerations are your clotting risk and your lifestyle (smoking, oral contraceptives).Stable clots further than 3-4 inches from the junction can be observed, as long as 30-40 mmHg compression hose are worn. Anticoagulation is another issue to be decided by the physician. Clots closer than 1-2 inches might be treated by high ligation of the great saphenous vein at the saphenofemoral junction to prevent clot migration upwards. I have not heard of ligation at the ankle, ever. High ligation may not be needed, but is well tolerated as the blood is detoured through connecting veins out of the leg. Anticoagulation only prevents growth of the clot, it is your body that will dissolve the clot with enzymes over several weeks to months.
Published on Jul 11, 2012
I'd need to know whether the clot is in a branch off the great saphenous vein, how far off the gsv and how far from the junction with the deep system. If the great saphenous vein is significantly insufficient and the clot does not involve the main trunk of the great saphenous vein, I would strongly consider endovenous ablation of the GSV to control the process, prevent migration of the svt into the gsv and possibly deep system, as well as definitively treat the great saphenous vein insufficiency. This is less invasive than high ligation, yet accomplishes the same goal. I would not favor observation alone, if the gsv is not insufficient then a short course of anti-coagulation would be my choice until thrombus is stabilized.
Published on Jul 11, 2012
I would not do "nothing". If the clot is progressing upward and is close to the femoral vein then ligating is best (clot can't migrate to the lungs.) The other option is to go on anti-coagulant medication. In either case, you should be wearing compression hose.
Published on Jul 11, 2012
I would close the vein above the clotted area with laser ablationassuming that there is enough room to place the laser above the clot. If the clot is close to the saphenous vein junction with the femoral vein, then I would ligate the saphenous vein at the saphenofemoral vein junction. Ligating or closing the vein above the clot will ensure that the clot will not move upward into the femoral vein and should not cause you any problems. You should see a vascular or vein specialist.
Published on Jul 11, 2012
Leaving this alone to scar down for now is appropriate. The use of anticoagulants(blood thinners) is controversial, but considered. If the saphenous vein is varicosed, then it should be ablated, sclerosed or
surgically removed when the clot has fully scarred downgreater than 6 months.
Published on Jul 11, 2012
You can observe or treat either is correct, depending on how much it bothers you. See a vein specialist who can provide all options and you're more likely to get an unbiased opinion.
answered by Michael Ingegno, M.D.
Published on Jul 11, 2012
Having a clot in your saphenous vein is referred to as superficial phlebitis. As long as it does not worsen and extend into the deep veins located in your groin, it is okay to treat conservatively for now. Conservative treatment would inlcude NSAIDs, compression stockings and warm compresses. If the phlebitis resolves over the next few months, laser ablation can be performed at that time to permanently close the vein. If the phlebitis persists and is no longer painful, we typically let it heal on its own over time.
Published on Jul 11, 2012
Should repeat the ultrasound study. Then just follow if the clot has not enlarged.
Published on Jul 11, 2012