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Superficial Thrombophlebitis

Everyone has veins in their body. Veins have the responsibility of transferring blood from all over the body to the lungs for oxygenation. In the legs there are two classes of veins- superficial and deep. Phlebitis means inflammation of the veins and thrombophlebitis means that a thrombus has caused inflammation of the veins. Phlebitis is commonly seen in both the superficial and deep veins of the legs. Most individuals and physicians are confused between superficial thrombophlebitis and deep vein thrombosis, for good reason.  Arguably these conditions are very similar and life threatening complications do occur.

How does superficial thrombophlebitis happen?

The a blood clot develops in the superficial veins of the leg. When the blood clot sits in the vein, it causes activation of the blood clotting mechanisms which results in the formation of a thrombus. During this period the body releases numerous chemicals, some which try to dissolve the clot and some which stimulate clot production. All these chemicals are irritating to the vein and cause a condition known as phlebitis.

Is superficial phlebitis harmful?

Although the majority of patients with superficial phlebitis will have a limited course of inflammation, serious complications often occur.  Deep vein clots and superficial clots share many of the same risk factors.  Because of the prevalent co-existence of both deep and superficial clots, a detailed ultrasound study is necessary to guide treatment.  In rare instances, superficial blood clots may break loose and travel to the lung.      

Which veins are prone to superficial thrombophlebitis?

The veins you seen underneath your skin and legs are superficial veins and it is these veins which are usually affected.  The superficial leg veins, particularly varicose veins, are most commonly affected by phlebitis.

What causes thrombophlebitis?

Any condition that causes irritation of the vein can cause phlebitis. The most common causes of superficial phlebitis include:

  • Personal/family history of blood clot or clotting disorder
  • Varicose veins
  • Advanced age
  • Intravenous catheters
  • Focal trauma
  • Self injection with dirty needle
  • Pregnancy/Peripeural period
  • Prolonged immobilization, i.e. long plane flights, or car rides in addition to post surgical settings when walking is delayed due to pain or casting
  • Malignancy/cancer

What are the symptoms of superficial thrombophlebitis?

The symptoms generally depend on the degree of inflammation and extent of vein involvement. In general most individuals will complain of:

  • Pain: Pain is a constant feature at the site and may be throbbing in nature. It ranges from mild to moderate
  • Tenderness: In some cases, the entire segment of the vein will be tender to touch
  • Swelling: Swelling may be prominent in the area of the inflammation
  • Fever: In severe cases, the individual will have a long segment of vein which becomes inflamed and then infected. Fever will then be a common feature
  • Hardness: Some individuals will present late to the physician and complain of hard rope like structure along the leg. This usually occurs as the end stage of recovery. Most veins which are inflamed tend to become fibrosed (hard) with time
  • Redness: In some cases, the entire leg may be red along the length of the vein

What is the treatment for superficial thrombophlebitis?

The treatment of superficial thrombophlebitis generally parallels that of deep vein thrombosis (DVT):

Compression therapy: Properly fitted compression stockings to provide support, decrease inflammation, and help limit risk of deep vein thrombosis.

Ambulation:  The scientific literature supports walking with compression to lessen the risk of deep vein thrombosis, and promote healing.  This is in stark contrast to bedrest which promotes an environment for clot expansion.
Anticoagulation vs. Anti-inflammatories:  The decision to anticoagulate is entirely based upon the ultrasound findings.  Because the incidence of combined deep and superficial phlebitis is common duplex scanning is essential.  If a clinical diagnosis is made and ultrasound is not available, low molecular weight heparin (LMWH) is indicated until a scan is completed.  If the scan is readily available and the superficial thrombus (blood clot) is confined to a varicose vein, anti-inflammatories are likely all that is needed.  

Anticoagulation vs. Anti-inflammatories: 
The incidence of developing deep vein thrombosis or pulmonary embolus occurs in one of every twenty patients within three months of the superficial thrombus.  For this reason it is often recommended that the ultrasound scan be repeated to monitor the affected limb until resolution of the problem is identified.

Final Advice

If you suspect you have superficial thrombophlebitis, it is best to have a physician look at the condition. Even though the majority of cases are benign and resolve, occasionally a clot in the deep veins may also be present and has to be treated differently.

Content reviewed by Dr. Marlin W. Schul, MD, MBA, RVT, FACPh with Lafayette Regional Vein Center.





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