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1. Background Information

a. Definition

• Thrombus + inflammation in a superficial vein
• Most commonly affects lower limb varicose veins
• Not benign → associated with DVT/PE risk

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b. Clinical Classification

• Isolated SVT (localised)
• Extensive SVT (≥5 cm)
• Proximal SVT:
  • Near saphenofemoral junction (SFJ)
• Recurrent / migratory SVT → consider malignancy

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c. Etiopathophysiology

• Due to Virchow’s triad:
  • Venous stasis (e.g. varicose veins)
  • Endothelial injury (e.g. cannulation)
  • Hypercoagulability (e.g. cancer, pregnancy)
• Leads to local clot + inflammation
• Can extend into deep veins → VTE

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🔍 2. Assessment

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a. Clinical Presentation

• Local signs:
  • Pain, tenderness
  • Erythema, warmth
  • Palpable cord-like vein
• Develops over hours–days, improves over weeks
• Consider:
  • DVT/PE symptoms (red flags)
• Recurrent/migratory → think underlying malignancy

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b. Relevant Investigations

🩻 First-line

• Duplex ultrasound:
  • Confirms SVT
  • Excludes concurrent DVT
  • Often recommended in most patients

❌ Not recommended

• D-dimer not used (NICE CKS)

🔎 Consider further tests if:

• Recurrent/unprovoked → malignancy/thrombophilia work-up

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⚠️ 3. Management (NICE CKS–Aligned)

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a. Emergency Care (Same-day admission)

• Suspected:
  • DVT
  • Pulmonary embolism (PE)
  • Severe infection/sepsis

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b. Referral

⚡ Urgent ultrasound / secondary care

• SVT:
  • Near SFJ
  • Proximal long saphenous vein
  • ≥5 cm or extensive
  • Diagnostic uncertainty

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🩸 Specialist (Haematology)

• Within 3 cm of SFJ → treat as DVT
• Recurrent SVT
• High risk of progression
• Unclear management

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🦵 Vascular referral

• Symptomatic varicose veins
• Suspected underlying pathology

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c. Primary Care Management (Low-risk SVT)

✅ Conservative

• Paracetamol ± NSAIDs
• Topical NSAIDs (mild/localised)

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🧴 Self-care

• Warm compresses
• Leg elevation
• Mobilisation (↓ DVT risk)
• Reassure:
  • Pain improves 1–2 weeks
  • Cord persists weeks–months

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🧦 Compression

• Consider graduated compression stockings
• Only if arterial insufficiency excluded

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🦠 Antibiotics

• Only if infection (cellulitis) suspected

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💉 Anticoagulation (High-yield AKT concept)

Offer prophylactic anticoagulation (e.g. fondaparinux 2.5 mg OD for 45 days) if:

• SVT ≥5 cm, OR
• Near deep venous system, OR
• Significant symptoms/risk factors

📌 Evidence:

• Reduces VTE, extension, recurrence
• Supported by BMJ Best Practice
• Confirmed in JAMA clinical evidence summary

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🔑 AKT Exam Pearls

• Measure length + location → drives management
• ≥5 cm → anticoagulate (fondaparinux 45 days)
• Within 3 cm of SFJ → treat as DVT
• Ultrasound often required to exclude DVT
• D-dimer NOT used
• Recurrent SVT → think malignancy