[Ascending thrombophlebitis of the greater saphenous vein: proposal of a new morphological classification].

: Superficial thrombophlebitis has been considered a self-limiting, benign disease without any significant incidence of morbidity or mortality. Thrombosis of the saphenous vein close to the deep venous system is a potentially dangerous clinical situation that may progress to deep venous thrombosis and pulmonary embolism. We retrospectively analysed 32 patients with ascending thrombophlebitis of the proximal greater saphenous vein who underwent emergency surgical ligation of the saphenofemoral junction. In 3 patients (9%) a femoral thrombectomy was performed because we observed an extension of the thrombus to the femoral vein intraoperatively. The postoperative morbidity and mortality rates were 0%, while the incidence of postoperative pulmonary embolism was 3%. In our opinion, emergency surgical ligation of the saphenofemoral junction is a valid alternative to medical treatment for thrombophlebitis of the proximal greater saphenous vein. At the moment no randomised comparison of the efficacy of different treatments tested in a large series is available. According to our experience and on the basis of the anatomical and haemodynamic studies conducted by Bisacci and Genovese, we have identified 2 different types of thrombophlebitis of the proximal greater saphenous vein, which require different treatments. In type 1, the thrombus does not reach the pre-ostial valve; simple ligation of the saphenofemoral junction after its opening is necessary. In type 2, the thrombus goes beyond the pre-ostial valve; thrombectomy, saphenofemoral disconnection and postoperative anticoagulation are mandatory.