PRINCIPLES OF ACUTE VARICOTHROMBOPHLEBITIS MANAGEMENT DURING PREGNANCY

Abstract

Thrombophlebitis of the subcutaneous veins of the lower extremities, also called superficial thrombophlebitis (ST), is a well-known and common disease often occurring in pregnant women with varicose veins (VV). As a rule, ST is considered as a disease with an uncomplicated and mild course, which is usually not life-threatening. However, in the case of appearance of concomitant deep vein thrombosis and/or pulmonary embolism, ST can cause severe complications. The article presents a clinical case of treatment of a pregnant woman (28 weeks of gestational age) with acute ascending varicothrombophlebitis in the system of the great saphenous vein (GSV). According to ultrasound data, the patient was found to have insufficiency of the sapheno-femoral junction and occlusive thrombosis of the lateral branches and the trunk of GSV, extending to the middle third of the left thigh. Taking into account the obstetric history, clinical and ultrasound picture of the disease, and the risk of perioperative complications, it was decided to prescribe prolonged anticoagulation with low-molecular-weight heparin(LMWH) and perform phlebocentesis of thrombosed GSV segments. The basic component of symptomatic treatment of ST was elastic compression. The chosen option for managing gestational varicotrombophlebitis allowed improving the patient’s overall health, as well as to quickly (within 2-3 days) arrest local inflammation and significantly reduce local edema and pain. The case presented highlights the possibility of successful and safe use of needle aspiration thrombectomy and anticoagulation with LMWH in pregnant women with ascending subcutaneous venous thrombosis.