Optimized Surgical Strategies for Acute Thrombophlebitis of Varicose Veins in the Lower Extremities

Optimized Surgical Strategies for Acute Thrombophlebitis of Varicose Veins in the Lower Extremities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Optimized Surgical Strategies for Acute Thrombophlebitis of Varicose Veins in the Lower Extremities Victor Olamiposi Olaiya, Vincentia Kuukua Agyekum, Fidelis Ejeheri, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5740878/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Purpose: This study aimed to evaluate and compare the efficacy of two-stage and single-stage surgical strategies in the management of acute thrombophlebitis of varicose veins in the lower extremities, focusing on postoperative complications, recovery time, and overall patient outcomes. Materials & Methods: A retrospective analysis was conducted on 102 patients diagnosed with acute thrombophlebitis of varicose veins between 2020 and 2024 at the Izhevsk Republic Clinical Hospital. Patients were classified according to F. Verrel’s classification (1998) into four groups based on the extent of thrombosis. Conservative therapy, single-stage radical phlebectomy, and two-stage surgical treatment (crossectomy followed by radical phlebectomy) were used based on the type of thrombosis and patient condition. Results: Of the patients, 17 received conservative therapy, 48 underwent two-stage surgery, and 37 underwent single-stage surgery. The two-stage approach significantly reduced complications such as wound infections (6.3% vs. 13.9%) and nerve damage (5.1% vs. 16.2%) compared to the single-stage approach. Additionally, patients undergoing the two-stage procedure showed improved quality of life and faster recovery times. Conclusion: The two-stage surgical strategy offers superior clinical outcomes over single-stage interventions, significantly reducing postoperative complications and enhancing recovery. It is recommended as the optimal treatment approach for acute thrombophlebitis of varicose veins, particularly in more severe cases. varicose vein disease thrombophlebitis crossectomy acute varicothrombophlebitis phlebectomy Figures Figure 1 Introduction Varicose vein diseases (VVD) are the most prevalent vascular disorder worldwide [ 1 ]. Complications arising from VVD, which occur in 0.3–8% of cases [ 1 , 2 ], predominantly affect individuals of working age, underscoring the significance of this condition in terms of social and occupational rehabilitation [ 3 ]. The most severe and life-threatening complication of VVD is acute varicothrombophlebitis (AVTP), which is observed in up to 13.1% of cases [ 4 , 5 ]. The progression of thrombosis into the deep venous system can lead to the development of deep vein thrombosis (DVT) and pulmonary embolism (PE). Reports suggest that the incidence of DVT in patients with AVTP ranges from 6–44% [ 4 , 6 , 7 ]. Moreover, severe chronic venous insufficiency (CVI) resulting from these conditions leads to permanent disability in up to 40% of cases [ 8 ]. Massive pulmonary embolism caused by acute varicothrombophlebitis occurs in 2–31.5% of cases, with a mortality rate as high as 98% [ 6 , 8 , 9 ]. Clinical observations reveal that due to delayed or incorrect diagnosis, patients with AVTP often do not receive adequate treatment. This shortfall leads to reduced quality of life, loss of work capacity, and even death [ 3 , 6 , 11 ]. Despite growing interest in the management of this condition, there remains no consensus on the indications for selecting treatment methods and their scope. While some authors advocate for conservative therapy [ 10 ], others argue that only surgical intervention effectively prevents and minimizes the risk of pulmonary embolism (PE) [ 4 , 5 , 11 ]. This ongoing debate highlights the need for further research, which formed the basis for the present study. Materials and Methods Study Design and Setting This retrospective cohort study was conducted at the vascular surgery department of Izhevsk Republic Clinical Hospital БУЗ УР "1 РКБ МЗ УР," Russia, between January 2020 and December 2024. A total of 102 ethnic Russian patients of the Udmurtia Republic diagnosed with acute thrombophlebitis of varicose veins (ATVP) of the lower extremities were included. The data was collected from the hospital's electronic patient database “РТ МИС.” Ethical approval for this study was obtained in agreement with the guidelines governing research involving human participants from the Institutional Review Board of Izhevsk State Medical Academy, Russia before data collection. Inclusion and exclusion criteria The criteria of which studies to include and exclude were established to ensure the rigorous selection of patients for this review, focusing on the critical aspects of ATVP and its management procedures. The inclusion criteria included, Patients aged 18 years or older, Ethnic Russians alone, patients with clinical diagnosis of ATVP confirmed via duplex ultrasonography, and patients with no prior surgical interventions for varicose veins within the past year. The following groups were excluded, patients with severe comorbid conditions contraindicating surgery (e.g., active malignancy, severe cardiovascular or pulmonary disease), pregnant and lactating women, also, patients’ presence of venous ulcers extending beyond chronic venous insufficiency (CVI) class C4. Patient Demography and Sample Size Calculation. The demographic profile of patients included 65 (63.7%) females and 37 (36.3%) males, with a mean age of 47.2 ± 11.3 years. A majority of patients (68%) presented with a history of chronic venous disease, and 21% were diagnosed with concurrent obesity (Body Mass Index (BMI) ≥ 30 kg/m²). The table below (Table 1 ) depicts the baseline characteristics of the patients involved and the demographic profile. The sample size was calculated based on expected differences in postoperative complications between conservative and surgical strategies. Using a significance level of 5% and power of 80%, the estimated minimum sample size was 98 patients. Table 1 Patient Demographics and Baseline Characteristics Parameter Value Total Patients 102 Gender 65 Females (63.7%), 37 Males (36.3%) Mean Age (years) 47.2 ± 11.3 Ethnicity Russians (100%) History of Chronic Venous Disease 68% Obesity (BMI ≥ 30 kg/m²) 21% Classification of Thrombosis The patients were classified using F. Verrel’s criteria (1998) as follows: Type I, where the thrombotic process is confined to superficial veins; Type II, involving proximal thrombosis at ostial valves; Type III, where thrombosis extends into the deep venous system; and Type IV, with deep venous system involvement through incompetent perforator veins. Interventions Three treatment modalities were implemented based on the extent of thrombosis and the patient's condition. The first approach, conservative therapy, was initiated with patients with localized thrombosis (Type I) and no evidence of deep vein involvement. It involved non-invasive management strategies aimed at controlling inflammation and preventing thrombus progression. For patients requiring more extensive intervention, the second approach was implemented, a two-stage surgical treatment. In the first stage, prophylactic crossectomy was performed to address proximal thrombosis at the ostial valves, combined with conservative management to reduce inflammation. Following the resolution of inflammation over one to six months, the second stage involved radical phlebectomy to remove the affected veins and restore venous function. The third treatment modality, single-stage radical phlebectomy, was primarily performed on younger patients with localized inflammation and superficial thrombosis classified as Type I or Type II. This strategy involved the immediate removal of thrombosed superficial veins in a single surgical procedure. By tailoring the interventions to the clinical presentation and severity of thrombosis, the study aimed to optimize patient outcomes while minimizing postoperative complications. Diagnostic Tools and Statistical Analysis All patients underwent duplex ultrasonography using a Mindray system (5–10 MHz transducer) to determine the thrombus location, extent, and characteristics. Pulmonary embolism (PE) was ruled out using chest radiography. Data were analyzed using Microsoft Excel. Continuous variables were expressed as means ± standard deviation (SD), while categorical variables were presented as frequencies and percentages. Comparisons between groups were made using ANOVA for continuous variables and the chi-square test for categorical variables. Statistical significance was set at p < 0.05. Results Patient Characteristics Among the 102 patients, 40 (39.2%) were classified as Type I thrombosis (superficial veins), 47 (46.1%) as Type II thrombosis (proximal valves), 4 (3.9%) as Type III thrombosis (deep venous system involvement), and 2 (2.0%) as Type IV thrombosis (incompetent perforator veins). The median disease duration before hospital admission was 7 days, ranging from 3 to 14 days. These details are summarized in Table 2 and illustrated in Fig. 1 . Table 2 Classification of Thrombosis Distribution Type of Thrombosis Number of Patients Percentage (%) Type I (Superficial Veins) 40 39.2 Type II (Proximal Valves) 47 46.1 Type III (Deep Venous System) 4 3.9 Type IV (Incompetent Perforators) 2 2.0 Treatment Outcomes The treatment outcomes were analyzed across three distinct approaches: conservative therapy, two-stage surgical treatment, and single-stage radical phlebectomy. These 3 distinct approaches helped us to check the incidence of complications, chronic venous insufficiency (CVI) management and outcomes regarding the social satisfaction of the patients. Conservative therapy was administered to 17 patients diagnosed with localized thrombosis (Type I). During a median follow-up period of 8 months, there was no evidence of progression to deep vein thrombosis (DVT) or pulmonary embolism (PE), reflecting the efficacy of this non-invasive approach in localized cases. The two-stage surgical treatment group, which included 48 patients, had a notably lower incidence of complications. Wound infections were reported in 3 patients (6.3%), significantly less than the 5 patients (13.5%) observed in the single-stage group. Nerve damage occurred in 2 patients (5.1%), and the median duration of hospitalization was 5 days, indicating faster recovery compared to the single-stage approach. The single-stage radical phlebectomy group, comprising 37 patients, experienced higher rates of complications. Nerve damage occurred in 6 patients (16.2%), while wound infections were observed in 5 patients (13.9%). The median duration of hospitalization in this group was 7 days, demonstrating a slower recovery compared to the two-stage approach. Comparative Outcomes During the analysis of comparative outcomes of two-stage, single-stage surgery, and conservative therapy, several important parameters indicated the differences in their efficacy, safety, and patient recovery profiles. The outcomes were highlighted as Table 3 shows that the two-stage surgical management had much better results as compared to the single-stage surgical intervention. Wound infections were observed at a rate of 6.3% in patients undergoing two-stage surgery, notably lower than the 13.9% seen in single-stage surgery. Conservative therapy, being non-invasive, did not report wound infections, underscoring its inherent advantage in avoiding surgical complications. Nerve damage was similarly more prevalent in single-stage surgery (16.2%) compared to two-stage surgery (5.1%). This discrepancy suggests that the staged approach may provide more controlled conditions, reducing the likelihood of such complications. Although subjective to the patients, quality-of-life improvement was highest in patients who had two-stage surgery, with patients reporting significant enhancements post-intervention. Single-stage surgery offered moderate improvements, while conservative therapy yielded only low levels of quality-of-life enhancement, likely due to the absence of direct corrective measures. Table 3 The comparative outcomes of the different types of treatment received by the patients including possible complications & outcome towards living quality improvement Parameter Two-Stage Surgery (%) Single-Stage Surgery (%) Conservative Therapy (%) Wound Infections 6.3 13.9 - Nerve Damage 5.1 16.2 - Quality of Life Improvement High Moderate Low Demographic and Clinical Trends Among the 102 patients, 80 (78.4%) presented with early-stage chronic venous insufficiency (CVI), while 5 patients (4.9%) had healed venous ulcers at presentation. Younger patients, with a mean age of 42.3 ± 8.7 years, were more likely to undergo single-stage radical phlebectomy due to limited thrombosis. The age distribution across the different treatment modalities is summarized in Table 4 . Table 4 Age Distribution Across Treatment Modalities Treatment Modality Mean Age (years) Standard Deviation Conservative Therapy 50.8 ± 10.2 Two-Stage Surgical Treatment 47.5 ± 11.1 Single-Stage Radical Phlebectomy 42.3 ± 8.7 Complications No occurrences of pulmonary embolism (PE) or fatality were observed in any of the therapy groups (Table 5 ). However, lymphorrhea developed in one patient (2.7%) undergoing single-stage radical phlebectomy, showing a greater risk of complications with this method. In contrast, mild hematomas were seen in 2 patients (4.17%) who received the two-stage surgical technique. These data imply that two-stage surgery may deliver a more controlled and safer outcome as compared with the single-stage technique. Table 5 Complication Rates by Treatment Type Complication Two-Stage Surgery (%) Single-Stage Surgery (%) Lymphorrhea - 2.7 Mild Hematomas 4.17 - Pulmonary Embolism (PE) None None Mortality None None Discussion The management of AVTP remains a challenging endeavor due to its potential for severe complications, including deep vein thrombosis (DVT), chronic venous insufficiency (CVI), and pulmonary embolism (PE). The findings of this study provide critical insights into optimizing surgical strategies, emphasizing the comparative advantages of two-stage surgical treatment over single-stage interventions. Comparative Efficacy of Surgical Approaches Our study highlights the superiority of the two-stage surgical strategy, demonstrating significant reductions in postoperative complications such as wound infection, nerve damage, and residual thrombotic veins. The reduced complication rates of 6.3% for wound infections and 5.1% for nerve damage in two-stage procedures compared to 13.9% and 16.2%, respectively, in single-stage interventions. This aligns with findings from earlier studies, which indicate that double staged interventions allow better control of inflammation and healing, subsequently minimizing postoperative morbidity [ 1 ]. Additionally, by addressing inflammation prior to radical phlebectomy, the two-stage approach ensures a more targeted and efficient removal of affected veins, consistent with principles of surgical precision and patient-centered care. Implications for Chronic Venous Insufficiency (CVI) Management Early-stage CVI in the majority of patients (78.4%) underlines the importance of timely intervention in AVTP cases. The progression of thrombosis into the deep venous system indicates a substantial risk for exacerbating CVI, leading to ulceration and significant functional disturbances. The reduced recurrence rates and enhanced recovery profiles observed in patients undergoing the two-stage surgical approach affirm its utility in mitigating CVI progression. Studies have shown the role of staged surgical interventions in maintaining long-term venous patency and reducing the incidence of secondary venous ulcers [ 2 ]. Role of Crossectomy in Preventing Thrombotic Progression Prophylactic crossectomy, as the first stage of the two-stage approach, effectively curtails thrombotic progression into the deep venous system, a finding consistent with previous evidence supporting its preventive role in acute thrombotic conditions [ 3 ]. By immediately addressing the proximal thrombosis at ostial valves, crossectomy minimizes the risk of complications such as PE, which remains a significant cause of mortality in AVTP patients. The delay between the initial crossectomy and subsequent radical phlebectomy further allows inflammation to subside, optimizing surgical outcomes and minimizing perioperative risks [ 4 ]. Patient Selection and Tailored Treatment The stratification of patients based on the extent of thrombosis, using F. Verrel’s classification, underscores the need for personalized surgical strategies. Patients with Type I thrombosis benefited significantly from single-stage radical phlebectomy, reflecting the less invasive nature of this approach for localized superficial thrombosis. However, the complexity of cases involving deeper venous system involvement (Types III and IV) necessitated more aggressive management, often involving two-stage interventions. This targeted approach not only ensures better outcomes but also reduces the overall burden of complications, aligning with the broader trend of individualized patient care in vascular surgery [ 5 , 11 ]. Clinical and Social Implications Beyond clinical outcomes, the two-stage surgical approach offers substantial social benefits by enhancing patient quality of life and reducing the economic burden associated with prolonged hospital stays and recurrent interventions. The observed reduction in hospitalization time and postoperative complications directly translates to improved functional outcomes, enabling patients to resume daily activities with minimal disruption. This aligns with evidence from population-based studies emphasizing the importance of optimizing surgical strategies to minimize long-term disability and healthcare costs [ 6 , 7 , 12 ]. Conclusion In conclusion, this study underscores the clinical and social advantages of the two-stage surgical strategy for managing acute thrombophlebitis of varicose veins. By reducing postoperative complications, enhancing patient recovery, and mitigating the risk of long-term sequelae such as CVI and PE, this approach represents a significant advancement in the treatment of AVTP. Two-stage surgical treatment demonstrates superior clinical and social effectiveness compared to single-stage interventions. It reduces complications and enhances patient outcomes, making it the recommended treatment of choice for acute thrombophlebitis of varicose veins in the lower extremities. This approach represents a significant step toward optimizing management strategies for this complex condition. However, further research is needed to refine these strategies, ensuring their applicability across diverse patient populations and healthcare settings. Abbreviations ATVP - Acute Thrombophlebitis of Varicose Veins BMI - Body Mass Index CVI - Chronic Venous Insufficiency DVT - Deep Vein Thrombosis ICMJE - International Committee of Medical Journal Editors PE - Pulmonary Embolism VVD - Varicose Vein Disease Declarations Author Contributions All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work. Acquisition, analysis, or interpretation of data: Victor O. Olaiya Drafting of the manuscript: Fidelis Ejeheri & Victor O. Olaiya Concept and design: Vincentia K. Agyekum & Victor O. Olaiya Critical review of the manuscript for important intellectual content: Johnson Matola Supervision: Johnson Matola Communication: Collaboration between authors was done primarily via WhatsApp & Zoom for regular meetings to discuss progress. Disclosures Ethics: Ethical approval for this study was conducted in agreement with the guidelines governing research involving human participants, as outlined by the Ethics Committee and Institutional Review Board of Izhevsk State Medical Academy, Russia before data collection started. Funding : There was no funding for this study Informed Consent : Informed consent was waived by the Institutional Review Board of Izhevsk State Medical Academy, Russia, as the study involved retrospective analysis of anonymized patient data. Human subjects : All authors have confirmed that this study involved human subjects and consent for type of treatment in this study was obtained from all participants by the Izhevsk Republic Clinical Hospital БУЗ УР "1 РКБ МЗ УР," Russia before treatment began. Animal subjects : All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest : In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info : All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships : All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships : All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. Data Availability Statement: The datasets generated during and/or analyzed during the period of study are not publicly available due to institutional policies regarding patient confidentiality but are available from the corresponding author upon reasonable request. Acknowledgement: We extend our gratitude to the medical and administrative staff of the Izhevsk Republic Clinical Hospital БУЗ УР "1 РКБ МЗ УР" for their support in facilitating this study and providing access to patient records. Special thanks to Dr. Bidanova Sofia, whose expertise in vascular imaging and technical knowledge greatly contributed to the diagnostic components of this research. We also acknowledge Dr. Dimitri Opolonski of the Izhevsk State Medical Academy, for his technical assistance in data management and analysis and guidance in manuscript preparation. We confirm that we have obtained permission from all individuals mentioned above to include their names in this acknowledgements section. References Hamdan A. Management of varicose veins and venous insufficiency. JAMA. 2012 Dec 26;308(24):2612-21. https://doi.org/10.1001/jama.2012.111352. PMID: 23268520. Shatalov AV, Beburishvili AG, Shatalov AA, Shabanov AA. 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Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord. 2024 Jan;12(1):101670. https://doi.org/10.1016/j.jvsv.2023.08.011. Epub 2023 Aug 29. Erratum in: J Vasc Surg Venous Lymphat Disord. 2024 Sep;12(5):101923. doi: 10.1016/j.jvsv.2024.101923 Gawas M, Bains A, Janghu S, Kamat P, Chawla P. A Comprehensive Review on Varicose Veins: Preventive Measures and Different Treatments. J Am Nutr Assoc . 2022 Jul;41(5):499-510. https://doi.org/10.1080/07315724.2021.1909510. Epub 2021 Jul 9. Titon JP, Auger D, Grange P, Hecquet JP, Remond A, Ulliac P, Vaissié JJ. Traitement curatif des thromboses veineuses superficielles par nadroparine calcique. Recherche posologique et comparaison à un anti-inflammatoire non stéroïdien [Therapeutic management of superficial venous thrombosis with calcium nadroparin. Dosage testing and comparison with a non-steroidal anti-inflammatory agent]. Ann Cardiol Angeiol (Paris). 1994 Mar;43(3):160-6. French. https://pubmed.ncbi.nlm.nih.gov/8024227/. Gosteva B. O., Ilyasova G. Sh., Kondratyuk E. R. Thrombosis Of Superficial Veins, A Modern View Of Diagnosis And Treatment // Achievements of Science and Education No. 6 (86), 2022 - P. Свободное цитирование при указании авторства: https://scientifictext.ru/images/PDF/2022/86/tromboz-poverkhnostnykh.pdf Bitsadze VO, Bredikhin RA, Bulatov VL, et al. Superficial phlebitis and thrombophlebitis. Journal of Venous Disorders. 2021;15(3):211‑244. (In Russ.) https://doi.org/10.17116/flebo202115031211 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5740878","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":400424558,"identity":"32860f69-63f2-4741-a785-1c7c531d4657","order_by":0,"name":"Victor Olamiposi Olaiya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYDACdhiDGQgZKkAM5gb8WphRtJwBMRiJ1QJiMraBaAJa+JmZn27mzdmWuOE482Nj3nm10fztQC0/Krbh1CLZzGZ2m3fb7cQNh9mMk3m3Hc+dcZixgbHnzG2cWgwOM0C0zGzmYT7Mu+1YbgNQCzNjGz4t7N+QtMw5ljufsBYeiC39zDzMybwNNbkbCGmRbOYpuzl3223jfmY2Y8M5xw7kbgRqOYjPL/zs7dtuvN12W7aN//BjiTc1dbnzzh8++OBHBW4tMODYACSYeBgOg3kHCKoHAnsQwfiDoY4YxaNgFIyCUTDCAAARrVrypRKqqgAAAABJRU5ErkJggg==","orcid":"","institution":"Izhevsk State Medical University","correspondingAuthor":true,"prefix":"","firstName":"Victor","middleName":"Olamiposi","lastName":"Olaiya","suffix":""},{"id":400424559,"identity":"27747f16-4a2f-400d-9c54-8c24b3e5ae7b","order_by":1,"name":"Vincentia Kuukua Agyekum","email":"","orcid":"","institution":"Izhevsk State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Vincentia","middleName":"Kuukua","lastName":"Agyekum","suffix":""},{"id":400424560,"identity":"24eff899-9cdd-41ab-afa4-7b25616e4220","order_by":2,"name":"Fidelis Ejeheri","email":"","orcid":"","institution":"Patrice Lumumba Peoples' Friendship University of Russia","correspondingAuthor":false,"prefix":"","firstName":"Fidelis","middleName":"","lastName":"Ejeheri","suffix":""},{"id":400424561,"identity":"83f07f56-d1c6-48fc-a0ff-e4a40cab23f4","order_by":3,"name":"Johnson Matola","email":"","orcid":"","institution":"Ndola Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Johnson","middleName":"","lastName":"Matola","suffix":""}],"badges":[],"createdAt":"2024-12-31 09:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5740878/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5740878/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73702330,"identity":"d0a1cb34-3692-48be-a05f-5aeef0b61cea","added_by":"auto","created_at":"2025-01-13 17:33:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26519,"visible":true,"origin":"","legend":"\u003cp\u003eClassifying patients into the F. Verrel’s criteria (1998) of Thrombosis classification\u003c/p\u003e","description":"","filename":"percentageofpatientswiththrombosisclassification.png","url":"https://assets-eu.researchsquare.com/files/rs-5740878/v1/f5304b800a11955879b15da6.png"},{"id":73702373,"identity":"00afecfb-85c7-4390-94c9-27518bd367bf","added_by":"auto","created_at":"2025-01-13 17:33:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":867376,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5740878/v1/782cdf98-3df7-401b-bc25-7cd3b8f00608.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optimized Surgical Strategies for Acute Thrombophlebitis of Varicose Veins in the Lower Extremities","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVaricose vein diseases (VVD) are the most prevalent vascular disorder worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Complications arising from VVD, which occur in 0.3\u0026ndash;8% of cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], predominantly affect individuals of working age, underscoring the significance of this condition in terms of social and occupational rehabilitation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most severe and life-threatening complication of VVD is acute varicothrombophlebitis (AVTP), which is observed in up to 13.1% of cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The progression of thrombosis into the deep venous system can lead to the development of deep vein thrombosis (DVT) and pulmonary embolism (PE). Reports suggest that the incidence of DVT in patients with AVTP ranges from 6\u0026ndash;44% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Moreover, severe chronic venous insufficiency (CVI) resulting from these conditions leads to permanent disability in up to 40% of cases [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Massive pulmonary embolism caused by acute varicothrombophlebitis occurs in 2\u0026ndash;31.5% of cases, with a mortality rate as high as 98% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinical observations reveal that due to delayed or incorrect diagnosis, patients with AVTP often do not receive adequate treatment. This shortfall leads to reduced quality of life, loss of work capacity, and even death [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Despite growing interest in the management of this condition, there remains no consensus on the indications for selecting treatment methods and their scope.\u003c/p\u003e \u003cp\u003eWhile some authors advocate for conservative therapy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], others argue that only surgical intervention effectively prevents and minimizes the risk of pulmonary embolism (PE) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This ongoing debate highlights the need for further research, which formed the basis for the present study.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e \u003cb\u003eStudy Design and Setting\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis retrospective cohort study was conducted at the vascular surgery department of Izhevsk Republic Clinical Hospital БУЗ УР \"1 РКБ МЗ УР,\" Russia, between January 2020 and December 2024. A total of 102 ethnic Russian patients of the Udmurtia Republic diagnosed with acute thrombophlebitis of varicose veins (ATVP) of the lower extremities were included. The data was collected from the hospital's electronic patient database \u0026ldquo;РТ МИС.\u0026rdquo; Ethical approval for this study was obtained in agreement with the guidelines governing research involving human participants from the Institutional Review Board of Izhevsk State Medical Academy, Russia before data collection.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe criteria of which studies to include and exclude were established to ensure the rigorous selection of patients for this review, focusing on the critical aspects of ATVP and its management procedures. The inclusion criteria included, Patients aged 18 years or older, Ethnic Russians alone, patients with clinical diagnosis of ATVP confirmed via duplex ultrasonography, and patients with no prior surgical interventions for varicose veins within the past year. The following groups were excluded, patients with severe comorbid conditions contraindicating surgery (e.g., active malignancy, severe cardiovascular or pulmonary disease), pregnant and lactating women, also, patients\u0026rsquo; presence of venous ulcers extending beyond chronic venous insufficiency (CVI) class C4.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePatient Demography and Sample Size Calculation.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe demographic profile of patients included 65 (63.7%) females and 37 (36.3%) males, with a mean age of 47.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3 years. A majority of patients (68%) presented with a history of chronic venous disease, and 21% were diagnosed with concurrent obesity (Body Mass Index (BMI)\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u0026sup2;). The table below (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) depicts the baseline characteristics of the patients involved and the demographic profile. The sample size was calculated based on expected differences in postoperative complications between conservative and surgical strategies. Using a significance level of 5% and power of 80%, the estimated minimum sample size was 98 patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Demographics and Baseline Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 Females (63.7%), 37 Males (36.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRussians (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Chronic Venous Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eClassification of Thrombosis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe patients were classified using F. Verrel\u0026rsquo;s criteria (1998) as follows: Type I, where the thrombotic process is confined to superficial veins; Type II, involving proximal thrombosis at ostial valves; Type III, where thrombosis extends into the deep venous system; and Type IV, with deep venous system involvement through incompetent perforator veins.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInterventions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThree treatment modalities were implemented based on the extent of thrombosis and the patient's condition. The first approach, conservative therapy, was initiated with patients with localized thrombosis (Type I) and no evidence of deep vein involvement. It involved non-invasive management strategies aimed at controlling inflammation and preventing thrombus progression.\u003c/p\u003e \u003cp\u003eFor patients requiring more extensive intervention, the second approach was implemented, a two-stage surgical treatment. In the first stage, prophylactic crossectomy was performed to address proximal thrombosis at the ostial valves, combined with conservative management to reduce inflammation. Following the resolution of inflammation over one to six months, the second stage involved radical phlebectomy to remove the affected veins and restore venous function.\u003c/p\u003e \u003cp\u003eThe third treatment modality, single-stage radical phlebectomy, was primarily performed on younger patients with localized inflammation and superficial thrombosis classified as Type I or Type II. This strategy involved the immediate removal of thrombosed superficial veins in a single surgical procedure. By tailoring the interventions to the clinical presentation and severity of thrombosis, the study aimed to optimize patient outcomes while minimizing postoperative complications.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDiagnostic Tools and Statistical Analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAll patients underwent duplex ultrasonography using a Mindray system (5\u0026ndash;10 MHz transducer) to determine the thrombus location, extent, and characteristics. Pulmonary embolism (PE) was ruled out using chest radiography. Data were analyzed using Microsoft Excel. Continuous variables were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while categorical variables were presented as frequencies and percentages. Comparisons between groups were made using ANOVA for continuous variables and the chi-square test for categorical variables. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003ePatient Characteristics\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong the 102 patients, 40 (39.2%) were classified as Type I thrombosis (superficial veins), 47 (46.1%) as Type II thrombosis (proximal valves), 4 (3.9%) as Type III thrombosis (deep venous system involvement), and 2 (2.0%) as Type IV thrombosis (incompetent perforator veins). The median disease duration before hospital admission was 7 days, ranging from 3 to 14 days. These details are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification of Thrombosis Distribution\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Thrombosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType I (Superficial Veins)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType II (Proximal Valves)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType III (Deep Venous System)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType IV (Incompetent Perforators)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTreatment Outcomes\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe treatment outcomes were analyzed across three distinct approaches: conservative therapy, two-stage surgical treatment, and single-stage radical phlebectomy. These 3 distinct approaches helped us to check the incidence of complications, chronic venous insufficiency (CVI) management and outcomes regarding the social satisfaction of the patients.\u003c/p\u003e \u003cp\u003eConservative therapy was administered to 17 patients diagnosed with localized thrombosis (Type I). During a median follow-up period of 8 months, there was no evidence of progression to deep vein thrombosis (DVT) or pulmonary embolism (PE), reflecting the efficacy of this non-invasive approach in localized cases.\u003c/p\u003e \u003cp\u003eThe two-stage surgical treatment group, which included 48 patients, had a notably lower incidence of complications. Wound infections were reported in 3 patients (6.3%), significantly less than the 5 patients (13.5%) observed in the single-stage group. Nerve damage occurred in 2 patients (5.1%), and the median duration of hospitalization was 5 days, indicating faster recovery compared to the single-stage approach.\u003c/p\u003e \u003cp\u003eThe single-stage radical phlebectomy group, comprising 37 patients, experienced higher rates of complications. Nerve damage occurred in 6 patients (16.2%), while wound infections were observed in 5 patients (13.9%). The median duration of hospitalization in this group was 7 days, demonstrating a slower recovery compared to the two-stage approach.\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparative Outcomes\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDuring the analysis of comparative outcomes of two-stage, single-stage surgery, and conservative therapy, several important parameters indicated the differences in their efficacy, safety, and patient recovery profiles. The outcomes were highlighted as Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the two-stage surgical management had much better results as compared to the single-stage surgical intervention.\u003c/p\u003e \u003cp\u003eWound infections were observed at a rate of 6.3% in patients undergoing two-stage surgery, notably lower than the 13.9% seen in single-stage surgery. Conservative therapy, being non-invasive, did not report wound infections, underscoring its inherent advantage in avoiding surgical complications.\u003c/p\u003e \u003cp\u003eNerve damage was similarly more prevalent in single-stage surgery (16.2%) compared to two-stage surgery (5.1%). This discrepancy suggests that the staged approach may provide more controlled conditions, reducing the likelihood of such complications.\u003c/p\u003e \u003cp\u003eAlthough subjective to the patients, quality-of-life improvement was highest in patients who had two-stage surgery, with patients reporting significant enhancements post-intervention. Single-stage surgery offered moderate improvements, while conservative therapy yielded only low levels of quality-of-life enhancement, likely due to the absence of direct corrective measures.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe comparative outcomes of the different types of treatment received by the patients including possible complications \u0026amp; outcome towards living quality improvement\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo-Stage Surgery (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle-Stage Surgery (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConservative Therapy (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound Infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNerve Damage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality of Life Improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDemographic and Clinical Trends\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong the 102 patients, 80 (78.4%) presented with early-stage chronic venous insufficiency (CVI), while 5 patients (4.9%) had healed venous ulcers at presentation. Younger patients, with a mean age of 42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7 years, were more likely to undergo single-stage radical phlebectomy due to limited thrombosis. The age distribution across the different treatment modalities is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge Distribution Across Treatment Modalities\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment Modality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Age (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConservative Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo-Stage Surgical Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle-Stage Radical Phlebectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComplications\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNo occurrences of pulmonary embolism (PE) or fatality were observed in any of the therapy groups (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). However, lymphorrhea developed in one patient (2.7%) undergoing single-stage radical phlebectomy, showing a greater risk of complications with this method. In contrast, mild hematomas were seen in 2 patients (4.17%) who received the two-stage surgical technique. These data imply that two-stage surgery may deliver a more controlled and safer outcome as compared with the single-stage technique.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplication Rates by Treatment Type\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo-Stage Surgery (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle-Stage Surgery (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild Hematomas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary Embolism (PE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe management of AVTP remains a challenging endeavor due to its potential for severe complications, including deep vein thrombosis (DVT), chronic venous insufficiency (CVI), and pulmonary embolism (PE). The findings of this study provide critical insights into optimizing surgical strategies, emphasizing the comparative advantages of two-stage surgical treatment over single-stage interventions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparative Efficacy of Surgical Approaches\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOur study highlights the superiority of the two-stage surgical strategy, demonstrating significant reductions in postoperative complications such as wound infection, nerve damage, and residual thrombotic veins. The reduced complication rates of 6.3% for wound infections and 5.1% for nerve damage in two-stage procedures compared to 13.9% and 16.2%, respectively, in single-stage interventions. This aligns with findings from earlier studies, which indicate that double staged interventions allow better control of inflammation and healing, subsequently minimizing postoperative morbidity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Additionally, by addressing inflammation prior to radical phlebectomy, the two-stage approach ensures a more targeted and efficient removal of affected veins, consistent with principles of surgical precision and patient-centered care.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications for Chronic Venous Insufficiency (CVI) Management\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEarly-stage CVI in the majority of patients (78.4%) underlines the importance of timely intervention in AVTP cases. The progression of thrombosis into the deep venous system indicates a substantial risk for exacerbating CVI, leading to ulceration and significant functional disturbances. The reduced recurrence rates and enhanced recovery profiles observed in patients undergoing the two-stage surgical approach affirm its utility in mitigating CVI progression. Studies have shown the role of staged surgical interventions in maintaining long-term venous patency and reducing the incidence of secondary venous ulcers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eRole of Crossectomy in Preventing Thrombotic Progression\u003c/b\u003e \u003c/p\u003e \u003cp\u003eProphylactic crossectomy, as the first stage of the two-stage approach, effectively curtails thrombotic progression into the deep venous system, a finding consistent with previous evidence supporting its preventive role in acute thrombotic conditions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. By immediately addressing the proximal thrombosis at ostial valves, crossectomy minimizes the risk of complications such as PE, which remains a significant cause of mortality in AVTP patients. The delay between the initial crossectomy and subsequent radical phlebectomy further allows inflammation to subside, optimizing surgical outcomes and minimizing perioperative risks [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003ePatient Selection and Tailored Treatment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe stratification of patients based on the extent of thrombosis, using F. Verrel’s classification, underscores the need for personalized surgical strategies. Patients with Type I thrombosis benefited significantly from single-stage radical phlebectomy, reflecting the less invasive nature of this approach for localized superficial thrombosis. However, the complexity of cases involving deeper venous system involvement (Types III and IV) necessitated more aggressive management, often involving two-stage interventions. This targeted approach not only ensures better outcomes but also reduces the overall burden of complications, aligning with the broader trend of individualized patient care in vascular surgery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical and Social Implications\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBeyond clinical outcomes, the two-stage surgical approach offers substantial social benefits by enhancing patient quality of life and reducing the economic burden associated with prolonged hospital stays and recurrent interventions. The observed reduction in hospitalization time and postoperative complications directly translates to improved functional outcomes, enabling patients to resume daily activities with minimal disruption. This aligns with evidence from population-based studies emphasizing the importance of optimizing surgical strategies to minimize long-term disability and healthcare costs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study underscores the clinical and social advantages of the two-stage surgical strategy for managing acute thrombophlebitis of varicose veins. By reducing postoperative complications, enhancing patient recovery, and mitigating the risk of long-term sequelae such as CVI and PE, this approach represents a significant advancement in the treatment of AVTP. Two-stage surgical treatment demonstrates superior clinical and social effectiveness compared to single-stage interventions. It reduces complications and enhances patient outcomes, making it the recommended treatment of choice for acute thrombophlebitis of varicose veins in the lower extremities. This approach represents a significant step toward optimizing management strategies for this complex condition. However, further research is needed to refine these strategies, ensuring their applicability across diverse patient populations and healthcare settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eATVP - Acute Thrombophlebitis of Varicose Veins\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI - Body Mass Index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCVI - Chronic Venous Insufficiency\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDVT - Deep Vein Thrombosis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICMJE - International Committee of Medical Journal Editors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePE - Pulmonary Embolism\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVVD - Varicose Vein Disease\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003eAcquisition, analysis, or interpretation of data: Victor O. Olaiya\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript:\u003cem\u003e\u0026nbsp;\u003c/em\u003eFidelis Ejeheri \u0026amp; Victor O. Olaiya\u003c/p\u003e\n\u003cp\u003eConcept and design: Vincentia K. Agyekum \u0026amp; Victor O. Olaiya\u003c/p\u003e\n\u003cp\u003eCritical review of the manuscript for important intellectual content: Johnson Matola\u003c/p\u003e\n\u003cp\u003eSupervision: Johnson Matola\u003c/p\u003e\n\u003cp\u003eCommunication: Collaboration between authors was done primarily via WhatsApp \u0026amp; Zoom for regular meetings to discuss progress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics:\u0026nbsp;\u003c/strong\u003eEthical approval for this study was conducted in agreement with the guidelines governing research involving human participants, as outlined by the Ethics Committee and Institutional Review Board of Izhevsk State Medical Academy, Russia before data collection started.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: There was no funding for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e: Informed consent was waived by the Institutional Review Board of Izhevsk State Medical Academy, Russia, as the study involved retrospective analysis of anonymized patient data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman subjects\u003c/strong\u003e: All authors have confirmed that this study involved human subjects and consent for type of treatment in this study was obtained from all participants by the Izhevsk Republic Clinical Hospital БУЗ УР \u0026quot;1 РКБ МЗ УР,\u0026quot; Russia before treatment began.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnimal subjects\u003c/strong\u003e: All authors have confirmed that this study did not involve animal subjects or tissue.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e: In compliance with the ICMJE uniform disclosure form, all authors declare the following:\u0026nbsp;\u003c/p\u003e\n\u003col style=\"list-style-type: upper-roman;\"\u003e\n \u003cli\u003e\u003cstrong\u003ePayment/services info\u003c/strong\u003e: All authors have declared that no financial support was received from any organization for the submitted work.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFinancial relationships\u003c/strong\u003e: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOther relationships\u003c/strong\u003e: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe datasets generated during and/or analyzed during the period of study are not publicly available due to institutional policies regarding patient confidentiality but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e We extend our gratitude to the medical and administrative staff of the Izhevsk Republic Clinical Hospital БУЗ УР \u0026quot;1 РКБ МЗ УР\u0026quot; for their support in facilitating this study and providing access to patient records. Special thanks to Dr. Bidanova Sofia, whose expertise in vascular imaging and technical knowledge greatly contributed to the diagnostic components of this research. We also acknowledge Dr. Dimitri Opolonski of the Izhevsk State Medical Academy, for his technical assistance in data management and analysis and guidance in manuscript preparation. We confirm that we have obtained permission from all individuals mentioned above to include their names in this acknowledgements section.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eHamdan A. Management of varicose veins and venous insufficiency. JAMA. 2012 Dec 26;308(24):2612-21. https://doi.org/10.1001/jama.2012.111352. PMID: 23268520.\u003c/li\u003e\n\u003cli\u003eShatalov AV, Beburishvili AG, Shatalov AA, Shabanov AA. Hemodynamic mechanism behind the development of acute crural vein varicothrombophlebitis in the great saphenous vein basin. Journal \u003cem\u003eof Venous Disorders .\u003c/em\u003e 2010; 4(3): 34‑38. (In Russ.) https://www.mediasphera.ru/issues/flebologiya/2010/3/031997-6976201036\u003c/li\u003e\n\u003cli\u003ePustovoĭt AA, Gavrilov SG, Zolotukhin IA. Tactics in patients with superficial thrombophlebitis. Journal \u003cem\u003eof Venous Disorders .\u003c/em\u003e 2011;5(3):46‑52. (In Russ.) https://www.mediasphera.ru/issues/flebologiya/2011/3/031997-6976201138\u003c/li\u003e\n\u003cli\u003eJorgensen JO, Hanel KC, Morgan AM, Hunt JM. The incidence of deep venous thrombosis in patients with superficial thrombophlebitis of the lower limbs. J Vasc Surg. 1993 Jul;18(1):70-3. https://doi.org/10.1067/mva.1993.42072. \u003c/li\u003e\n\u003cli\u003eDuffett L, Kearon C, Rodger M, Carrier M. Treatment of Superficial Vein Thrombosis: A Systematic Review and Meta-Analysis. Thromb Haemost. 2019 Mar;119(3):479-489. d https://doi.org/10.1055/s-0039-1677793. \u003c/li\u003e\n\u003cli\u003eVerlato F, Zucchetta P, Prandoni P, Camporese G, Marzola MC, Salmistraro G, Bui F, Martini R, Rosso F, Andreozzi GM. An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg. 1999 Dec;30(6):1113-5. https://doi.org/10.1016/s0741-5214(99)70051-0. PMID: 10587397.\u003c/li\u003e\n\u003cli\u003eMurgia AP, Cisno C, Pansini GC, Manfredini R, Liboni A, Zamboni P. Surgical management of ascending saphenous thrombophlebitis. Int Angiol. 1999 Dec;18(4):343-7. https://pubmed.ncbi.nlm.nih.gov/10811526/\u003c/li\u003e\n\u003cli\u003eGloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord. 2024 Jan;12(1):101670. https://doi.org/10.1016/j.jvsv.2023.08.011. Epub 2023 Aug 29. Erratum in: J Vasc Surg Venous Lymphat Disord. 2024 Sep;12(5):101923. doi: 10.1016/j.jvsv.2024.101923\u003c/li\u003e\n\u003cli\u003eGawas M, Bains A, Janghu S, Kamat P, Chawla P. A Comprehensive Review on Varicose Veins: Preventive Measures and Different Treatments. \u003cem\u003eJ Am Nutr Assoc\u003c/em\u003e. 2022 Jul;41(5):499-510. https://doi.org/10.1080/07315724.2021.1909510. Epub 2021 Jul 9.\u003c/li\u003e\n\u003cli\u003eTiton JP, Auger D, Grange P, Hecquet JP, Remond A, Ulliac P, Vaissi\u0026eacute; JJ. Traitement curatif des thromboses veineuses superficielles par nadroparine calcique. Recherche posologique et comparaison \u0026agrave; un anti-inflammatoire non st\u0026eacute;ro\u0026iuml;dien [Therapeutic management of superficial venous thrombosis with calcium nadroparin. Dosage testing and comparison with a non-steroidal anti-inflammatory agent]. Ann Cardiol Angeiol (Paris). 1994 Mar;43(3):160-6. French. https://pubmed.ncbi.nlm.nih.gov/8024227/. \u003c/li\u003e\n\u003cli\u003eGosteva B. O., Ilyasova G. Sh., Kondratyuk E. R. Thrombosis Of Superficial Veins, A Modern View Of Diagnosis And Treatment // Achievements of Science and Education No. 6 (86), 2022 - P.\u003cbr\u003e Свободное цитирование при указании авторства: https://scientifictext.ru/images/PDF/2022/86/tromboz-poverkhnostnykh.pdf \u003c/li\u003e\n\u003cli\u003eBitsadze VO, Bredikhin RA, Bulatov VL, et al. Superficial phlebitis and thrombophlebitis. \u003cem\u003eJournal of Venous Disorders. \u003c/em\u003e2021;15(3):211‑244. (In Russ.)\u003cbr\u003e https://doi.org/10.17116/flebo202115031211\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"varicose vein disease, thrombophlebitis, crossectomy, acute varicothrombophlebitis, phlebectomy","lastPublishedDoi":"10.21203/rs.3.rs-5740878/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5740878/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e This study aimed to evaluate and compare the efficacy of two-stage and single-stage surgical strategies in the management of acute thrombophlebitis of varicose veins in the lower extremities, focusing on postoperative complications, recovery time, and overall patient outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials \u0026amp; Methods:\u003c/strong\u003eA retrospective analysis was conducted on 102 patients diagnosed with acute thrombophlebitis of varicose veins between 2020 and 2024 at the Izhevsk Republic Clinical Hospital. Patients were classified according to F. Verrel’s classification (1998) into four groups based on the extent of thrombosis. Conservative therapy, single-stage radical phlebectomy, and two-stage surgical treatment (crossectomy followed by radical phlebectomy) were used based on the type of thrombosis and patient condition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of the patients, 17 received conservative therapy, 48 underwent two-stage surgery, and 37 underwent single-stage surgery. The two-stage approach significantly reduced complications such as wound infections (6.3% vs. 13.9%) and nerve damage (5.1% vs. 16.2%) compared to the single-stage approach. Additionally, patients undergoing the two-stage procedure showed improved quality of life and faster recovery times.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The two-stage surgical strategy offers superior clinical outcomes over single-stage interventions, significantly reducing postoperative complications and enhancing recovery. It is recommended as the optimal treatment approach for acute thrombophlebitis of varicose veins, particularly in more severe cases.\u003c/p\u003e","manuscriptTitle":"Optimized Surgical Strategies for Acute Thrombophlebitis of Varicose Veins in the Lower Extremities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 17:33:39","doi":"10.21203/rs.3.rs-5740878/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-12T15:52:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-08T14:27:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-08T11:04:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35930696763908117927645085883006619555","date":"2025-02-02T13:37:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207416848961255090922116477051606575768","date":"2025-02-02T09:27:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-30T17:05:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-30T08:45:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103245583148065113379175158412570732713","date":"2025-01-25T10:14:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70683445343517092555115171393024832628","date":"2025-01-23T14:48:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-17T10:53:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-10T10:40:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-09T11:26:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Medicine","date":"2024-12-31T09:20:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3a4adefa-5090-4431-9484-9829182036e6","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-15T06:53:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-13 17:33:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5740878","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5740878","identity":"rs-5740878","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}