Superficial thrombophlebitis Information | Mount Sinai

Thrombophlebitis – superficial

Thrombophlebitis is a swollen or inflamed vein due to a blood clot. Superficial refers to veins just below the skin’s surface.

Superficial thrombophlebitis is an inflammation of a vein just below the surface of the skin, which results from a blood clot. This condition may occur after recently using an IV line, or after trauma to the vein. Some symptoms can include pain and tenderness along the vein and hardening and feeling cord-like. Superficial thrombophlebitis is usually a benign and short-term condition. Symptoms generally subside in 1 to 2 weeks, but hardness of the vein may remain for much longer.

Shown here is erythema following the vascular pattern on a lower extremity. The superficial veins have become inflamed and dilated, causing the discoloration.

Causes

This condition may occur after injury to the vein. It may also occur after having medicines given into your veins. If you have a high risk for blood clots, you may develop them for no apparent reason.

Risks for thrombophlebitis include:

• Cancer or liver disease
• Deep vein thrombosis
• Disorders that involve increased blood clotting (may be inherited)
• Infection
• Pregnancy
• Sitting or staying still for a prolonged period
• Use of birth control pills
• Swollen, twisted, and enlarged veins (varicose veins)

Symptoms

Symptoms may include any of the following:

• Skin redness, inflammation, tenderness, or pain along a vein just below the skin
• Warmth of the area
• Limb pain
• Hardening of the vein

Exams and Tests

Your health care provider will diagnose this condition based mainly on the appearance of the affected area. Frequent checks of the pulse, blood pressure, temperature, skin condition, and blood flow may be needed.

Ultrasound of the blood vessels helps confirm the condition.

If there are signs of an infection, skin or blood cultures may be done.

Treatment

To reduce discomfort and swelling, your provider may recommend that you:

• Wear support stockings, if your leg is affected.
• Keep the affected leg or arm raised above heart level.
• Apply a warm compress to the area.

If you have a catheter or IV line, it will likely be removed if it is the cause of the thrombophlebitis.

Medicines called NSAIDs, such as ibuprofen, may be prescribed to reduce pain and swelling.

If clots in the deeper veins are also present, your provider may prescribe medicines to thin your blood. These medicines are called anticoagulants. Antibiotics are prescribed if you have an infection.

Surgical removal (phlebectomy), stripping, or sclerotherapy of the affected vein may be needed. These treat large varicose veins or to prevent thrombophlebitis in high-risk people.

Outlook (Prognosis)

This is usually a short-term condition that does not cause complications. Symptoms often go away in 1 to 2 weeks. Hardness of the vein may remain for much longer.

Possible Complications

Complications are rare. Possible problems may include the following:

• Infections (cellulitis)
• Deep vein thrombosis

When to Contact a Medical Professional

Contact your provider for an appointment if you develop symptoms of this condition.

Also contact your provider if you already have the condition and your symptoms worsen or do not get better with treatment.

Prevention

In the hospital, swollen or inflamed veins can be prevented by:

• The nurse regularly changing the location of your IV line and removing it if swelling, redness, or pain develop
• Walking and staying active as soon as possible after surgery or during a long-term illness

When possible, avoid keeping your legs and arms still for long periods. Move your legs often or take a stroll during long plane trips or car trips. Try to avoid sitting or lying down for long periods without getting up and moving about.

Cardella JA, Amankwah KS. Venous thromboembolism: prevention, diagnosis, and treatment. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1072-1082.

Wasan S. Superficial thrombophlebitis and its management. In: Sidawy AN, Perler BA, eds. Rutherford’s Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 150.

Last reviewed on: 5/10/2022

Reviewed by: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Superficial Thrombophlebitis | Michigan Medicine

Superficial thrombophlebitis is a form of venous disease (disease of the veins) that occurs when a blood clot forms that partially or totally blocks blood flow in a vein in the superficial venous system. When this occurs in the deep venous system, it is called deep vein thrombosis or DVT,  which is  more serious because of the risk of a piece of clot breaking loose and traveling to the lungs (called pulmonary embolus, or PE). This can impair breathing and can even cause death.

Symptoms of Superficial Venous Thrombophlebitis and Deep Venous Thrombophlebitis

Signs and symptoms of superficial venous thrombophlebitis are:

• A hard cord-like feeling along a vein
• Soreness over this area, redness and warmth over the vein
• Swelling in the area
• Limb pain

People with deep venous thrombophlebitis (DVT) may have:

• No signs or symptoms
• Sudden swelling of the limb
• Pain or aching of the limb
• Fever
• Skin discoloration in severe cases

Learn more about Deep Vein Thrombosis (DVT).

Risk Factors for Superficial Thrombophlebitis

Superficial thrombophlebitis may occur after injury to the vein or the recent use of an intravenous (IV) line or catheter. Some people with a high risk for this condition may develop it in lieu of any of these risk factors:

• Chemical irritation of the area
• Disorders that involve increased blood clotting
• Infection
• Pregnancy
• Sitting or staying still for a prolonged period
• Use of birth control pills or hormone replacement therapy
• Varicose veins
• Malignancy
• Chronic venous insufficiency

Diagnosis of superficial thrombophlebitis may be made based on appearance of the affected area. Other tests can be used to confirm the diagnosis, including:

• Ultrasound
• Venography
• Blood culture, if there is a sign of infection

Treatments for Superficial Thrombophlebitis

Superficial thrombophlebitis is treated with elevation of the leg, anti-inflammatory medicines such as Motrin, mild pain relievers if needed and warm, moist soaks to the area either continuously or every 4-6 hours as needed. Elastic bandages or compression stockings are also used from the base of the toes to below the knee or higher. A short course of  low-molecular weight heparin (LMWH), Lovenox or Fondaparinux may also be prescribed. Antibiotics are used if there is sign of infection. Additionally, certain patients may benefit from surgical correction of superficial venous insufficiency.

The Venous Health Program at the University of Michigan Cardiovascular Center

The Venous Health Program at the University of Michigan Frankel Cardiovascular Center is an all-inclusive resource for the treatment of venous disease. This program brings together established and experienced vascular surgeons, vascular medicine specialists, interventional radiologists and nurse practitioners to provide seamless multidisciplinary care.

Patient Resources

• Deep Vein Thrombosis Information Guide

Make an Appointment

Visit our Make an Appointment page for more information.

What provokes thrombosis

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Content:

• What causes thrombosis

• How alcohol provokes thrombosis

• Vaccination provokes thrombosis: truth or myth?

• Which foods provoke thrombosis

• Preventive measures, diagnosis and treatment

In case of damage to blood vessels, the mechanism of stopping blood loss is activated, due to which clots form in the blood. This is a normal process, essential for life support. But in some cases, blood clots appear even if the vessel is not physically damaged. Thrombosis can be very dangerous, threatening not only health, but also life. Broken blood clots (emboli) can clog a part of the vessel, causing the death of large parts of the organ: the heart, lung, intestines, etc.

What causes thrombosis

The main causes of thrombosis are increased blood clotting, changes in the nature and direction of blood flow, as well as damage to arteries and veins. All these violations are observed for various reasons: there can be many triggers, and in each case it is necessary not only to get rid of blood clots, but also to look for the underlying disease.

Factors provoking thrombosis:

• Smoking, alcohol abuse.
• Serious disorders of the respiratory system, eg asthma.
• Age over 45 years.
• Overweight.
• Genetic anomalies.
• Autoimmune diseases.
• Taking hormones, including in the form of contraceptives.
• Traumatic injuries, operations, amputation of limbs.
• Blood poisoning.
• Infections affecting the walls of blood vessels.
• Cancers and at the same time some types of treatment of malignant tumors.
• Stagnation due to low mobility. Both the way of life and the nature of work, as well as forced immobility as a result of injuries, illnesses or heavy weight, matter here.
• Stagnation due to diseases of the heart and blood vessels, including varicose veins.
• Frequent and long-term air travel.

The risk of thrombosis increases during pregnancy and in the postpartum period, so patients require special monitoring. People who are bedridden or who have undergone surgery are immediately at risk, as the risk of congestion increases.

How alcohol provokes thrombosis

Any alcohol-containing drinks, even aged and high-quality ones, negatively affect the vascular system and all organs. Let’s figure out how ethanol affects a person:

• A frequent drinker’s blood becomes thicker over time, and the risk of blood clots increases.
• Ethanol provokes jumps in blood pressure, which increases the load on the vessels: fragility increases, resistance to injury decreases.
• In a drinker, fat deposits linger in the vessels, plaques increase in size faster than in those who do not drink alcohol.

It is a mistake to believe that strong drinks somehow help blood vessels. Of course, there are long-lived alcoholics, but should we follow their example? Especially if you are already at risk, for example, due to a disease or lifestyle.

Vaccination provokes thrombosis: truth or myth?

Repeated studies have shown that coronavirus provokes thrombosis. People who did not really understand the issue concluded that the vaccine provokes thrombosis. Blood clots do not form in every patient; people with a severe course of the disease are at risk. There are at least two explanations for why blood clots appear:

• During illness, immunoglobulins are produced, and antibodies provoke thrombosis.
• Forced lying position contributes to congestion.

Patients who carry the disease at home are at risk. In the hospital, patients can receive anticoagulants, but the need for therapy should be established individually. It is impossible to drink blood-thinning drugs on their own because of the high risks of provoking bleeding.

However, back to the question of why the vaccine provokes thrombosis. Modern covid vaccines are drugs that were urgently developed to build immunity and reduce the burden on doctors. Like any drug, the vaccine has side effects, but they occur extremely rarely – only 0.0005% of cases. For comparison, complications in the form of blood clots are observed in every fourth patient who had a severe covid. It is incorrect to say that Sputnik provokes thrombosis. In terms of action, our vaccine is not inferior to foreign analogues, and even surpasses in safety, since side effects are observed 2 times less often.

Which foods provoke thrombosis

Patients with hypercoagulability should consult with their doctor about the elimination of foods with vitamin K from the diet. The fact is that it affects the clotting system. It can be said that green tea and many green herbs and spices provoke thrombosis.

In addition, patients at risk need to be careful with foods that contribute to the accumulation of bad cholesterol. These are yolks, cattle meat, fatty cheese, butter. Diet advice is also necessary for diabetic patients whose blood vessels are damaged due to metabolic disorders.

Prevention, diagnosis and treatment

The advice to prevent any kind of CVD is the same – it’s a healthy lifestyle. With regard to thrombosis, the following recommendations can be made:

• Monitor the course of the underlying disease, which increases the risk of thrombosis.
• If you are going to have surgery, talk to your doctor about compression during this period. Few patients know that it is necessary to bandage the legs, regardless of which area is being operated on.
• Do not self-administer therapy. Even if hypercoagulation is found in you, the approach should be individualized with an accurate dosage selection. In addition, various drugs are used to dissolve blood clots in veins and arteries.
• Do not forget that varicose veins are not just an aesthetic problem, but a risk factor for thrombosis. A defective vein can be switched off from the bloodstream using various techniques, including low-traumatic ones (i.e., without surgery and incisions).
• Do not take oral contraceptives if your doctor has prescribed pills without testing. Choosing the right OC will help keep you healthy.
• See a doctor during pregnancy and after childbirth.

If you suspect that you have a thrombosis or want to calm down and make sure that there are no blood clots, come to us, to the Chekhov Vascular Center of the Moscow Region, to undergo the necessary examination. 142301

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Question to the doctor: how to avoid thrombosis

What can be done to reduce the risk of thrombosis? What role does heredity play in the occurrence of thrombosis? What examination do you need to undergo to check the condition of your blood vessels? What research methods are used today? Does everyone need anticoagulants at a certain age?
These and other questions of patients are answered by the cardiovascular surgeon of the N. N. A.V. Vishnevsky, Candidate of Medical Sciences, Associate Professor Zaurbek Akhsarbekovich Adyrkhaev.

– What role does heredity play in the occurrence of thrombosis?

– In terms of heredity, there are several factors that may predetermine an increased risk of thrombosis. The first of them is genetic mutations, of which there are at least 12. With arterial thrombosis, this is also congenital hypercholesterolemia and hyperhomocysteinemia. These and other hereditary factors that are capable of predetermining an increased predisposition to thrombosis, both venous and arterial, at the level of blood rheology, can be detected using laboratory diagnostics.

– Are arterial thromboses and atherosclerotic plaques the same phenomena?

– Plaques can increase the risk of arterial thrombosis by narrowing the lumen of the vessel and thereby contribute to a change in the spectrum of blood flow in this area. Or they are fragmented – and then their pieces can come off, closing the lumen of the vessel or impeding local blood flow in it, which leads to a decrease in blood flow and the formation of blood clots in this area.

– What is the difference between a thrombus and a plaque? Do they have different structures?

– A plaque is a denser formation, while a thrombus is a blood clot. A fresh blood clot is purple-red, soft, somewhat reminiscent of a slug in structure.

– Why does it form in some and not in others? What is the mechanism of such thickening of the blood?

– All vascular doctors know the rules of the “Virchow triad” (Rudolf Virchow – German pathologist, pioneer in the pathophysiology of thrombosis). In order for the process of thrombus formation to be started, three factors must necessarily take place: slowing of blood flow, damage to the endothelium (the inner lining of the vessel) and coagulopathy (increased blood clotting). Only in the presence of these three factors is it possible to form a blood clot. One factor is not enough, but if it is present, as a rule, others join it and sooner or later begin to manifest themselves. Simply put, if a patient has hereditary coagulopathy, he is already at risk. He can go on a long 8-hour flight, fall asleep on an airplane and not wake up, because a factor such as a decrease in blood flow will join his coagulopathy.

– When does it decrease?

– With prolonged static loads – if a person stands for a long time, or sits, or rides in a car, flies in an airplane … In a word, being in a stationary state contributes to the formation of venous thrombosis. At risk are also patients who have some kind of concomitant pathology – oncological diseases, gynecological diseases that require the use of hormonal drugs. By the way, oral contraceptives also increase these risks.

Arterial thrombosis very rarely occurs without the presence of systemic atherosclerosis. Another risk factor for their occurrence, of course, is a violation of the heart rhythm. If a patient even with unexpressed atherosclerosis has atrial fibrillation, then against its background, blood clots form in the heart, which can migrate and close the vessels, including the main ones – up to the aorta and iliac arteries, causing acute ischemia of the vessels of the legs.

– In what parts of the body do blood clots usually form?

– In case of venous thrombosis, the most common localization is the deep veins of the legs. The danger lies in the fact that the thrombus quickly rises from the lower extremities into the femoral iliac veins. This carries with it enormous risks of pulmonary embolism – what is often called by the people “a blood clot has come off.” This is the most formidable complication of venous thrombosis, and, of course, if it is not diagnosed in time, it carries a real threat to the patient’s life.

With arterial thrombosis, the most common complication is embolism in the aortic bifurcation, when the iliac arteries close, as well as embolism in the leg artery. The most commonly affected arteries are the tibia and the superficial femoral arteries, although others may also be affected. Here we are already talking about saving the limb, because, as a rule, such patients experience acute ischemia, which requires emergency surgery to restore blood flow in the leg. And if this is not done within the next few hours, the patient may lose his leg.

– And if there is a thrombosis, but it is asymptomatic, what should prompt a person to go to the doctor?

– Here we also have to separate venous and arterial thromboses. In the first case, this is, as a rule, a feeling of tension in the lower limb, sometimes already visually assessed by its swelling, pain and redness along the veins that are visible on the leg. These moments should, of course, alert, especially if this happens after the episodes that we talked about – taking hormonal drugs, pregnancy in women in the 3rd trimester, long journeys, sedentary work … If a person feels tension, swelling and pain in the limbs, as well as redness and hyperemia along the vein, of course, he should see a doctor.

If the thrombosis is localized only in the veins of the lower leg, it can often even go unnoticed for the patient, and we will find out about it later – when he is examined for some other reason. When doing an ultrasound, we see that the veins are changed, and even if there are no blood clots, there are signs that the patient has suffered a thrombosis.

As for arterial thrombosis, it is hard not to notice it. If the blood flow in any segment of the limb stops suddenly, the patient will somehow feel it. Of course, this is acute pain, coldness of the limb. The longer ischemia lasts, the more neurological complications join – in the form of leg numbness, limitation of movement in the ankle, in the knee joint. In the later stages, of course, there is swelling.

The most difficult stage is the formation of the so-called contracture in the knee and ankle joints, when the patient can no longer move his leg independently due to severe pain as a result of muscle spasm. The color of the leg changes, it becomes pale at first, then a marble color appears. Severe episodes of acute ischemia are accompanied by such dangerous complications as foot phlegmon, etc.

If this process develops rapidly, it can lead to wet gangrene, when the patient can no longer be helped. Therefore, it is so important not to miss the first symptoms – a sharp pain that becomes permanent, cold feet, discoloration of the skin. And, of course, you should not try to be treated with home remedies, you need to urgently consult a doctor.

– What is the difference between dopplerography of the vessels of the legs and ultrasound, and in what cases is this study done?

– Doppler examination shows mainly the speed characteristics of blood flow, it is not aimed at determining the state of the internal lining of the vessel, visualizing plaques or blood clots that nest there. This is no longer informative today, and in our routine practice we are switching to color duplex scanning. It allows you to get complete data on both the speed characteristics of blood flow and the state of the vessel as a whole: the thickness of its wall, the degree of inflammation, if any, the presence or absence of atherosclerotic plaques, how much they narrow the lumen of the vessel, whether there are blood clots in it or not, how much they spread, how many centimeters of the vessel they occupy, how tightly they are fixed to the wall (which is also very important).

– We are talking about the legs, but there are blood clots in the vessels of the head. Or is that a different story?

– Such thrombosis leads to a formidable complication – a stroke. Today in Moscow, and indeed throughout Russia, a huge number of vascular centers have been opened, which are designed to deal with acute coronary syndromes and acute strokes. Thrombosis results in the so-called stroke on the go, that is, the patient has the entire stroke clinic (a part of the body, arm or leg goes numb, speech is disturbed, etc.). If an ambulance arrives on time for such a patient, it will take him to one of the vascular centers, where an attempt will be made either systemic or local thrombolysis (dissolution of blood clots), or mechanical thromboextraction, when this thrombus is removed from the artery using special devices.
Now there are all the possibilities for this, and they cope with these states quite successfully. The main thing is to do everything on time, to get into the so-called therapeutic window (from 6 to 12 hours).

– There is an opinion that after a certain age everyone needs to take blood-thinning drugs, and everything will be fine.

– Let’s start with what a person can do on his own in order to protect himself as much as possible. First and foremost is an active lifestyle. Need aerobic exercise. I tell my patients: you should walk 30-60 minutes a day, and not walking, but accelerating up to 3-4 km per hour. Do Nordic walking, swim, do whatever you like, but be sure to keep moving! And in the air you should spend at least half an hour or an hour a day, and spend it actively. Of course, it is necessary to give up smoking – this is a proven fact of the risk of atherosclerosis and any complications of atherothrombosis.

Third, of course, food. Now the most popular diet, which sounds in all the recommendations, is the Mediterranean. It’s affordable and easy to stick to. The principles are very simple: limiting the consumption of animal fats and red meat (up to 1-2 times a week), the predominance of vegetable fats and fish, the basis of the diet is plant foods and vegetable proteins.

And another important point. In order to reduce the risk of thrombosis, it is necessary to observe an adequate regimen of hydration of the body. A person must consume the required amount of fluid per day, and this is no less than a liter and a half (with soup, jelly, water, tea – it is not necessary to drink only pure water). By consuming liquid, you achieve blood thinning in a physiological way. If a person does not regularly get fluid and there is not enough of it in his bloodstream, naturally, the blood will thicken, and the concentration of red blood cells per 1 ml of blood will increase. In this situation, he can, for example, go to the bathhouse and return from there with venous or arterial thrombosis. Sweating, a person loses up to several liters of fluid, which means that the same amount must be replenished.

Now about drugs. I believe that no one should take anything without a doctor’s recommendation. Outpatient therapists are now very educated in the field of prevention and possible complications of cardiovascular diseases, therefore, each person should be observed in the clinic, undergo a medical examination, which is being revived in our country, and if there are problems, be registered with a cardiologist or therapist, who, in accordance with with indications will prescribe therapy. And you can’t drink a drug that is heard or prescribed to a neighbor.

Previously, everyone was prescribed aspirin to reduce the risk of heart attacks and strokes – and now studies have begun to appear that speak of the dubious benefits of uncontrolled and general prescription of aspirin. 40 percent of people are generally tolerant to this drug, that is, when taking aspirin, they do not get the effect for which they drink it. And no one who prescribes this aspirin is tracking the expected effect. But everyone has a negative effect on the stomach and has long been proven.

– But there are new generations of antiplatelet agents.

– They are also not indicated for everyone, because they thin the blood so much that they entail a risk of bleeding. Yes, someone needs them, especially after 50 years, but they should be prescribed by doctors according to indications. Everyone must do their job. The doctor – to treat, and the patient – being responsible for his health – try to lead a healthy lifestyle to the maximum and contact doctors in a timely and periodic manner.

– You talked about a healthy lifestyle. And if, say, a blood clot already exists or is forming, can’t fitness provoke its movement?

– If at the age of 50 you decide to take up fitness for the first time in your life, of course, you should be examined first. Before starting classes, you must pass elementary fitness testing. This is not at all when they tell you how and which simulator works, you should be consulted by a doctor who will determine your tolerance for physical activity, make tests under the control of an ECG and other devices.

– Let’s simulate such a situation. The person knows that in his family there were strokes and cases of blood clots. And he wants to protect himself as much as possible. What examinations should he do to check the condition of the vessels?

– Firstly, a general and biochemical blood test, for a lipid profile – to find out the atherogenic index (the ratio of high and low density lipoproteins).

It is necessary to pass a coagulogram – look at the blood clotting parameters, make an ECG, measure the ankle-brachial index, which reflects the state of blood circulation in the lower extremities. If this index is lowered, we can talk about systemic atherosclerosis. It is necessary to determine the level of homocysteine ​​in the blood (an increased level can also indicate atherosclerotic complications), as well as an ultrasound of the carotid arteries.

I would not lose sight of the ultrasound of the abdomen, which can look for an aortic aneurysm, which is often the first manifestation of the disease in a patient with atherosclerosis. And, of course, if a more in-depth examination is carried out, an echocardiogram will be required to see if the heart muscle is functioning normally.

The brain, heart and lower limbs are the risk points for atherosclerosis and blood clots for a person who knows his hereditary predisposition to these diseases. And the listed studies are the minimum that will allow him to draw up a primary picture.

– And then live in peace?

– Not really. The person who did all these studies should then come to the doctor. Even if the indicators are within the normal range, this may be the upper limit of the norm, which already indicates some kind of change.