Superficial vein thrombosis is no longer considered a benign entity. It carries a 25% chance of concurrent DVT, which may not be contiguous with the SVT, at the time of diagnosis. There is also a risk of thrombus extension, thrombus recurrence, and development of symptomatic DVT and PE over the ensuing three months. Treatment with prophylactic or therapeutic doses of anticoagulation will depend on thrombus length, location, and risk stratification. Patients with SVT in the absence of varicose veins or superficial axial venous reflux should be considered for a hypercoagulable workup and screening for occult malignancy. If superficial axial venous reflux is demonstrated on duplex ultrasound, consideration should be given to endovenous ablation procedures once the patient is out of the pro-thrombotic period. This definitive treatment of underlying venous insufficiency may prevent SVT recurrence, which can occur in 10% to 20% of patients over time.