Résumé
Superficial vein thrombosis: a pathology to reconsider
Superficial vein thrombosis (SVT) of the lower limbs has long been considered as benign. Moreover, therapeutic recommendations concerning this disease have a relatively weak level of certitude as no treatment has been proved of benefit. Recent studies may change our perception of this disease. The prospective epidemiological POST study, which included 844 patients, showed that SVT was closely related to deep vein thrombosis (DVT) and pulmonary embolism (PE). Firstly, DVT, on systematic ultrasonography, and symptomatic PE were diagnosed in 24.9 % of SVT patients. Secondly, in SVT patients without DVT or PE at the initial assessment ("isolated" SVT), the rate of symptomatic thromboembolic events at three months was 8.3 %, despite the majority of patients being treated. These results highlight the importance of performing a complete compression ultrasonographic examination of the lower limbs in patients with suspected SVT. The CALISTO study was a randomized double-blind study comparing fondaparinux with placebo in 3002 patients with acute, isolated, symptomatic lower-limb SVT. The results showed that once-daily 2.5 mg fondaparinux for 45 days reduced the incidence of a composite of confirmed symptomatic events comprising all-cause death, PE, DVT, extension of SVT to the sapheno-femoral junction or recurrence of SVT by 85 % (p<0.001) without increasing the bleeding risk. Overall, these results represent a major step towards a better understanding and management of SVT.