Superficial thrombophlebitis

• Superficial thrombophlebitis:

  • Inflammation of the superficial vein system associated with venous thrombosis
  • Typically affects the lower limb and usually involves the long or short saphenous veins or their branches
• Most cases of superficial vein thrombosis (SVT) are spontaneous, usually in people with varicose veins. It can also result from venous stasis or injury or trauma to normal veins or varicosities
• Risk factors:

  • Biggest risk factor is varicose veins
  • Increasing age
  • Obesity
  • Active cancer
  • Previous thrombophlebitis or DVT
  • Pregnancy and the puerperium (up to 6 weeks postpartum)
  • Oral contraception and HRT use
  • Intravenous cannulation and infusion
  • Prolonged immobility
  • Autoimmune disease - particularly Behcet's and Buerger's disease
  • Coagulation disorder
• Clinical features:

  • Red, tender, palpable, firm lump or cord - typically located in an area of pre-existing varicose veins, particularly along a segment of the great saphenous vein
  • May be associated itch, warmth, and swelling of the surrounding tissues
  • May be haemosiderin-based brown pigmentation over the affected superficial veins
• Consider arranging admission or referral for an urgent venous duplex ultrasound scan to confirm the diagnosis if:

  • Suspected thrombophlebitis affecting the proximal long saphenous vein (upper thigh)
  • Suspected thrombophlebitis at the saphenofemoral junction at thigh level (near groin)
  • Extensive thrombophlebitis, measuring 5cm or more, or affecting both the thigh and the calf
  • Diagnosis is uncertain
• Do not use D-dimer blood test to diagnose suspected superficial thrombophlebitis
• Referral to thrombosis clinic:

  • if within 3cm of the saphenofemoral junction, therapeutic anticoagulation should be considered
  • With risk factors for extension, recurrence or progression
  • Recurrent episodes with no obvious underlying cause or risk factor
  • Any uncertainty about optimal management
• If suspected thrombophlebitis but low risk and admission/referral is not needed:

  • OTC NSAIDs until the pain settles (1-2 weeks) - can use topical NSAIDs, vein may be palpable and tender for several weeks to months
  • Apply a warm, moist towel or flannel to the affected limb
  • Keep the leg elevated when sitting
  • Continue to use the affected limb and remain mobile to reduce list of DVT
  • Offer prescription for compression stockings if arterial insufficiency has been excluded
  • Consider topical or oral antibiotics if there are signs of infection
• Patients with superficial thrombophlebitis at, or extending towards, the sapheno-femoral junction can be considered for therapeutic anticoagulation for 6-12 weeks.
• Some places will give all patients anticoagulation (LMWH for 30days) to reduce the risk of DVT, alongside compression stockings
• Complications:

  • VTE - DVT and PE
  • Recurrence and extension of the thrombophlebitis
  • Infection - particularly if the result of intravenous cannulation - risk of cellulitis and/or sepsis