Thrombophlebitis, Superficial

• • 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)

Epidemiology

• • Saphenous vein most common vein affected

  • 20% of patients have simultaneous DVT

Symptoms and Signs

• • 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)

Rule Out

• • Ascending lymphangitis

  • Cellulitis

  • Erythema nodosum

  • Erythema induratum

  • Panniculitis

• • Physical exam

  • CBC

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

  • Ambulation encouraged

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

Surgery

• • 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

Indications

• • > 2 wks duration or local recurrence

  • Septic patient

Treatment Monitoring

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

Prognosis

• • Uncomplicated superficial thrombophlebitis: Responds well to conservative therapy

  • Extension into DVT associated with PE

References