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  • • Can occur spontaneously in varicose veins, pregnant or postpartum women, thromboangiitis obliterans, Behçet disease

    • Most common after IV therapy, area of local trauma

    • Superficial migratory phlebitis (Trousseau): Suggests abdominal carcinoma

    • Pulmonary embolism (PE) is rare without deep venous thrombosis (DVT)

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Epidemiology

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  • • Saphenous vein most common vein affected

    • 20% of patients have simultaneous DVT

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Symptoms and Signs

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  • • Local extremity pain, redness

    • Indurated, erythematous, tender areas = thrombosed superficial veins; tends to be well localized over superficial vein

    • Firm cord may develop with time

    • Generalized edema absent unless deep veins involved

    • Fever or chills suggests septic or suppurative phlebitis (complication of IV cannulation)

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Rule Out

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  • • Ascending lymphangitis

    • Cellulitis

    • Erythema nodosum

    • Erythema induratum

    • Panniculitis

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  • • Physical exam

    • CBC

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  • • Primary treatment: NSAIDs, heat, elevation, support stockings, elastic wrap

    • Ambulation encouraged

    • Anticoagulation with monthly venous duplex can be attempted to avoid surgery

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Surgery

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  • • Excision of vein if persists > 2 wks or recurrent

    • Ligate and resection vein at junction of saphenofemoral or cephalic-subclavian junction

    • Septic thrombophlebitis: Broad-spectrum antibiotics; if patient is septic, immediate excision of infected vein

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Indications

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  • • > 2 wks duration or local recurrence

    • Septic patient

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Treatment Monitoring

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  • • Usually resolves in 7-10 days; is self-limited

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Prognosis

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  • Uncomplicated superficial thrombophlebitis: Responds well to conservative therapy

    • Extension into DVT associated with PE

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References

Di Nisio M et al: Treatment for superficial thrombophlebitis of the leg. Cochrane Database of Syst Rev 2007;2:CD004982.
Lucia MA et al: Images in clinical medicine: superficial thrombophlebitis. N Engl J Med 2001;344:1214.  [PubMed: 11309636]
Sullivan V et al: Ligation versus anticoagulation: treatment of above-knee superficial thrombophlebitis not involving the deep venous system. J Am Coll Surg 2001;193:556.  [PubMed: 11708514]

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