What is phlebitis?
Phlebitis is a term used to describe veins that are painful, red and inflamed.
What is thrombophlebitis?
Thrombophlebitis means there is a blood clot in the vein (thrombosis or thromboembolism) that causes swelling and pain.
Superficial thrombophlebitis: If the vein that has the clot is just under the skin, it is called a superficial venous thrombosis or superficial thrombophlebitis. This type of clot does not usually travel to the lungs unless it reaches the deep veins. But, superficial thrombophlebitis can be painful and treatment may be needed.
Deep vein thrombosis (DVT): If the blood clot is in the veins deep in the body, it is called a deep vein thrombosis (DVT). This type of clot can travel to the lungs (pulmonary embolism) and block blood flow to the lungs. In severe cases, this can lead to death. Most DVTs require treatment right away.
What are the symptoms of thrombophlebitis?
- Swelling of the leg or arm (sometimes this happens suddenly)
- Pain or tenderness in the area of the clot
- Feeling of increased warmth in the area of the clot
- Red or discolored skin in the area of the clot
If thrombophlebitis causes pain or interferes with your daily activities, talk to your doctor about treatment options.
How is superficial thrombophlebitis diagnosed?
Your doctor may suspect that you have superficial thrombophlebitis based on a physical exam. But, a vascular ultrasound is needed to confirm the diagnosis. An ultrasound is also important because about 20% of people with superficial thrombophlebitis also have a DVT.
Many times, patients who have superficial thrombophlebitis wait to see a doctor, thinking they have a muscle strain or sprain. In fact, without an ultrasound, the doctor may also think the problem is related to a muscle.
What causes superficial thrombophlebitis?
Superficial thrombophlebitis can be caused by an injury to the arm or leg; having an intravenous (IV) line; or the cause may not be known.
Potential risk factors are the same as for those who have deep vein thrombosis (DVT), and include:
- An inherited (family) condition that increases your risk of blood clots
- Cancer and some cancer treatments (chemotherapy)
- Limited blood flow because of an injury, surgery, or not moving
- Long periods of inactivity that decrease blood flow, such as:
- Sitting for a long time, such as in a car, truck, bus, train or airplane
- After surgery or a serious injury
- Pregnancy and the first 6 weeks after giving birth
- Being over age 40 (although clots can form at any age)
- Being overweight
- Taking birth control pills or hormone therapy, including for treatment for postmenopausal symptoms
- Placement of a central venous catheter or pacemaker
What are the treatment options for patients with superficial thrombophlebitis?
The main goal when you begin treatment for superficial thrombophlebitis is to control pain and inflammation. Treatment includes:
- Nonsteroidal anti-inflammatory pain medication (NSAIDs) such as ibuprofen
- Warm compresses
For inflammation and swelling:
- Leg elevation when you are resting
- Compression stockings
- Staying active and not sitting for too long
Other medical treatments:
Most times, treatment for patients with superficial thrombophlebitis includes only ways to manage pain and inflammation. But, if you are at risk of developing a DVT or have problems that affect the way your blood clots, you will likely need to take anticoagulation medication.
In most cases, superficial thrombophlebitis clears up within a few weeks.
When is surgery necessary for phlebitis?
If you have superficial thrombophlebitis and varicose veins, your doctor may talk to you about surgical treatment. The combination of these conditions puts you at greater risk of having superficial thrombophlebitis after the condition clears up. The best way to reduce this risk is to use surgery or endovenous therapy to take care of the varicose veins and keep them from returning. These procedures are performed by a vascular specialist in either the hospital or an outpatient surgery center.
Types of surgery include:
Endovenous ablation. A special catheter (long, thin tube) is placed in the saphenous vein (the longest vein in your body; it runs along the inside of your leg). The catheter is inserted by making a small puncture in your calf. Once it is in place, electric currents (radiofrequency) or laser energy is sent through the catheter to the area of the vein. This stops the backward blood flow in the vein that leads to varicose veins. Your doctor may also combine this procedure with another to remove large varicose veins through very small incisions (ambulatory phlebectomy).
Endovenous ablation is a less painful and less invasive alternative to surgical ligation and stripping, which is rarely used anymore.
Sclerotherapy. A solution is injected directly into the affected vein. The solution irritates the lining of the vessel, causing it to swell and stick together. Over time, the vessel turns into scar tissue that fades from view. This treatment is performed in the office by a vascular specialist or surgeon. It does not involve a hospital stay. Many times, the doctor will perform sclerotherapy along with endovenous ablation to take care of all varicose veins in the leg.
Your healthcare provider will talk to you about the best treatment for you.
References and resources:
- Thrombophlebitis, Medline Plus; National Library of Medicine
- Stoller JK, Michota FA, Mandell BF, Cleveland Clinic Foundation, Ovid Technologies, Inc. Venous Thromboembolic Disease. In: The Cleveland Clinic Intensive Review of Internal Medicine. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; March 28, 2012.
- Fernandez L, Scovell S. Superficial thrombophlebitis of the lower extremity. Uptodate, Nov. 3, 2014; http://www.uptodate.com/contents/superficial-thrombophlebitis-of-the-lower-extremity Accessed 8/4/2015