Section 3. Heart and Blood Vessel Disorders

Chapter 36. Venous Disorders

Introduction | Deep Vein Thrombosis | Superficial Thrombophlebitis | Varicose Veins | Arteriovenous Fistula

Superficial Thrombophlebitis

Superficial thrombophlebitis (superficial phlebitis) is inflammation and clotting in a superficial vein.

Superficial thrombophlebitis most often affects the superficial veins in the legs but may also affect superficial veins in the groin. Often, thrombophlebitis occurs in people with varicose veins; however, most people with varicose veins do not develop thrombophlebitis.

Even a slight injury can cause a varicose vein to become inflamed. Unlike deep vein thrombosis, which causes very little inflammation, superficial thrombophlebitis involves a sudden (acute) inflammatory reaction that causes the thrombus to adhere firmly to the vein wall and lessens the likelihood that it will break loose. Unlike deep veins, superficial veins have no surrounding muscles to squeeze and dislodge a thrombus. For these reasons, superficial thrombophlebitis rarely causes embolism.

Thrombophlebitis that repeatedly occurs in normal veins is called migratory phlebitis or migratory thrombophlebitis. It may indicate a serious underlying disorder, such as cancer of an internal organ. When migratory phlebitis and cancer of an internal organ occur together, the disorder is called Trousseau's syndrome.

Symptoms and Diagnosis

Localized pain and swelling develop rapidly, the skin over the vein becomes red, and the area feels warm and is very tender. Because blood in the vein is clotted, the vein feels like a hard cord under the skin, not soft like a normal or varicose vein. The vein may feel hard along its entire length. The diagnosis is usually obvious to doctors just from examining the painful area. However, doctors must distinguish superficial thrombophlebitis from cellulitis, which is treated differently.

Treatment

Most often, superficial thrombophlebitis subsides by itself. Taking an analgesic, such as aspirin or another nonsteroidal anti-inflammatory drug (NSAIDs) (see Section 6, Chapter 78), usually helps relieve the pain. Although the inflammation generally subsides in a matter of days, several weeks may pass before the lumps and tenderness subside completely. To provide early relief, doctors may inject a local anesthetic, remove the thrombus, and then apply a compression bandage, which the person wears for several days.

When superficial thrombophlebitis occurs in the groin, where the main superficial vein joins the main deep vein, a thrombus may extend into the deep vein. Such a thrombus may break loose to become an embolus. To prevent this extension, some surgeons recommend emergency surgery to tie off the superficial vein. Usually, this surgery can be performed using a local anesthetic and without admitting the person to the hospital. Normal activities may be resumed afterward.