Superficial Thrombophlebitis

Abstract

Superficial thrombophlebitis is defined as inflammation and thrombosis of a vein near the skin's surface. Most studies underestimate the occurrence of superficial thormbophlebitis and although the greater or lesser saphenous veins are the most commonly affected veins, this disease can occur at any part of the body. This condition is often associated with a long term intravenous (IV) catheter and is differentiated from septic thrombophlebitis by the absence of systemic signs of infection. Risk factors include recent venous catheterization, a history of previous superficial venous thrombosis, DVT or PE, recent surgery, trauma, pregnancy, high dose estrogen therapy, immobilization, malignancy, varicose veins, obesity, or intravenous drug abuse. Superficial thrombophlebitis remains a clinical diagnosis. Symptoms include localized pain and warmth over the site and patients will present with tenderness to palpation, induration, and erythema over a palpable cord. It is noted that superficial thrombophlebitis coexists with DVT in up to 53% of cases and PE in up to 33% of cases. Superficial thrombophlebitis can progress rapidly to venous thromboembolism (VTE) in as much as 15% of cases. Even though most times superficial thrombophlebitis will resolve on its own, it is not considered to be self limited and complications can occur. These include extension from a superficial vein to a deep vein, postphlebitic syndrome, chronic DVTs, suppurative thrombophlebilitis and septic thrombophlebitis. The aim of treatment is to alleviate symptoms and prevent extension to deep veins. The mainstay of treatment consists of extremity elevation, warm compresses, and the use of non-steroidal anti-inflammatory drugs (NSAID). Most patients respond to this conservative management regime with symptom resolution or improvement in 7-10 days. There is some evidence that shows the use of subtherapeutic doses of low molecular weight heparin can help in prevention of extension of superficial thrombophlebitis to DVT but there are no large multicenter trials to support this and make it standard of care.