[Stage-adapted therapy concept in ascending thrombophlebitis].

Varicophlebitis is the most frequent and important acute complication of a varicosed long and/or short saphenous vein. In view of the controversial discussion about the either conservative or surgical treatment, a clinically relevant classification of this syndrome appears useful: Stage I includes varicophlebitis without involvement of the respective junctional valve--in the groin or at the knee--and deep veins. While in Stage II the proximal part of the thrombus has reached the respective junctional valves of the long or short sapheneous vein, in Stage III it has entered the deep veins by means of these valves. In Stage IV the thrombus migrates via insufficient perforating veins into the deep system. Stages I and IV should be treated conservatively first, removal of the varicous veins should be performed after regression of the acute symptoms. Stages II and III should be considered an indication for urgent surgery. The surgical strategy consists of crossectomy, resection of the saphenous vein without stripping, radical excision of all varicous veins and ligature of insufficient perforating veins. In stage III the thrombectomy of the deep veins using the Fogarty-procedure must be carried out before any other measures are taken. In 1996 a total number of 40 limbs with ascending varicophlebitis (stage I = 16, stage II = 19, stage III = 5) was observed. 10 extremities (stage I = 2, stage II = 5, stage III = 3) underwent surgical treatment. 1 patient developed a deep infection of the groin, the average stay in hospital was 9 days.