Surface thrombophlebitis

Author Ольга Кияница

2019-02-03

The veins may become inflamed and clogged with blood clots. If the vessels involved in the pathological process, closely passing along the surface of the skin, then speak of superficial thrombophlebitis. According to its clinical signs and site of defeat it can be different, but most often in the pathological process involves the vessels of the legs, which leads to thrombophlebitis of the lower extremities.

Superficial thrombophlebitis (PTF) is a form of inflammatory disease of the veins in which a blood clot forms and partially or completely blocks blood flow in a vessel belonging to the superficial venous system. When this happens in the deep venous system, then they talk about deep vein thrombosis or DVT. This disorder is more serious because of the risk of a part of the clot coming off and moving it to the lungs, which causes a pulmonary embolism, or PE. As a result, breathing may deteriorate, and in severe cases, the person dies.

The mechanism of development of PTF depends on the specific etiology of the disease. For example, varicose veins and prolonged bed rest most often cause thrombophlebitis due to slower blood flow through the superficial veins.

The diagnosis of superficial thrombophlebitis is established after a medical examination and additional examinations by type of ultrasound, etc. Even a mild PTF must be properly and promptly treated so that serious complications such as pulmonary embolism can be avoided.

Video: Thrombophlebitis causes, symptoms, diagnosis, treatment, pathology

Description of thrombophlebitis of superficial veins

The basis for the development of thrombophlebitis is an inflammatory reaction in the area of ​​the thrombosed vein, manifested by painful compaction with redness of the skin. Thrombophlebitis of the superficial veins of the lower extremities is most common, but there is also information about thrombophlebitis of the veins of the neck, hands, and mammary glands.

The disease can occur after a vein injury. Sometimes the development of PTF is associated with the administration of drugs by the intravenous route. If there is a high risk of blood clots, especially with hereditary disorders of hypercoagulation. PTF can also develop for no apparent reason.

Risk factors for the development of superficial thrombophlebitis:

  • Nonspecific:
    • Phlebeurysm
    • Long immobilization
    • Obesity
    • Elderly age
    • Postoperative condition
  • Traumatic / septic:
    • Using a catheter (coated plastic)
    • Using a catheter on the upper or lower limbs
    • Cancer, debilitating diseases
    • Burn disease
    • AIDS
    • Intravenous drug use
  • Aseptic:
    • Pregnancy
    • Estrogen-based oral contraceptives
    • Surgical intervention, trauma, infection
    • Hypercoagulable state (i.e. factor V, deficiency of protein C or S, others)
  • Thromboangiitis obliterans: persistent smoking
  • Behcet, Burger, Mondor's disease
    • Breast cancer or breast surgery

Thrombophlebitis of the arm is most often caused by improper use of an intravenous catheter, whereas superficial thrombophlebitis of the lower limbs is mainly associated with varicose veins.

Prevalence of surface thrombophlebitis

Dominant age among patients

  • Traumatic and post-injection PTF are not characterized by prevailing age and gender.
  • Aseptic primary hypercoagulative disorder:
  • Children and young people.

Secondary aseptic state of hypercoagulation

  • Mondor disease occurs more often in women aged 21 to 55 years.
  • Thromboangiitis obliterans is peculiar to age from 20 to 50 years.

Dominance by gender

  • Purulent PTF of the same develops among both men and women.
  • Aseptic:
  • Spontaneously develops in women in 55–70% of cases.
  • Mondor disease is more common in women than in men (2: 1).

The diagnosis of surface thrombophlebitis can be made on the basis of detection of the affected area. Additional research methods can be used to confirm the diagnosis, including:

  • Dopplerography
  • Phlebography
  • Bacterial blood culture if there are signs of infection

Types of superficial thrombophlebitis

In the clinic, superficial thrombophlebitis is distinguished by reason of occurrence. The most common traumatic thrombophlebitis, thrombophlebitis with varicose veins, infectious thrombophlebitis. Migration thrombophlebitis and Mondor's disease are not so common.

Traumatic thrombophlebitis

Superficial thrombophlebitis mainly occurs after a limb injury, manifesting itself as a reddish band along the vein, near the injury area. Ecchymosis may be present in the early stages of the disease, indicating excessive blood secretion associated with vein damage. This may gradually turn into brown pigmentation of the vein, especially at the stage of resolving inflammation.

Thrombophlebitis often occurs at the site of intravenous infusion and is the result of exposure to irritating drugs, hypertonic solutions, intraluminal catheter, or the cannula itself. Today it is the most common type of thrombophlebitis.Usually redness and pain signal its presence during the infusion, but thrombosis can appear as small lumps a few days or weeks after the removal of the infusion apparatus. As a result, the pathological process may take several months before full recovery occurs.

The features of the iatrogenic form of traumatic (chemical) thrombophlebitis can be intentionally caused by sclerotherapy, which is most often carried out in the treatment of varicose veins.

Thrombophlebitis with varicose veins

Superficial thrombophlebitis is often considered a complication of varicose veins. The inflammatory process can spread up and down through the saphenous vein or is defined as a limited accumulation in secondary tributaries far from the main saphenous vein.

Although thrombophlebitis can occur due to injury, it often occurs with varicose veins without a preceding cause.

Thrombophlebitis with varicose veins develops as a hard-to-touch knot, often surrounded by erythema. Bleeding can sometimes occur when an inflammatory reaction spreads through the vein wall. PTF is often observed with varicose veins surrounding venous ulcers.

Infectious thrombophlebitis

Thrombophlebitis occurring against the background of infection (Staphylococcus aureus, Pseudomonas, Klebsiella, Peptostreptococcus sp., Candida sp.) Is associated with several different conditions, including a serious complication of intravascular cannulation. It is most often combined with persistent bacteremia when prescribing appropriate antibiotic therapy. In such cases, PTF is characterized by perivascular inflammation with or without signs of pus formation in the venous lumen. Also, thrombophlebitis is often caused by an infectious lesion of any part of the circulatory system.

In 1932, DeTakats suggested that dormant infection in the varicose vein system is a factor in the development of thrombophlebitis that occurs after surgery or after injection treatment, trauma, or exposure to radiation therapy.

Migratory thrombophlebitis

Jadioux described migrating thrombophlebitis in 1845, determining that it is a disease characterized by recurring thrombosis that develops in the superficial veins in different places. Still most common in the lower extremities. Although numerous reasons for the development of this pathological condition were proposed, not one of them was finally confirmed.

The first joint development of carcinoma with migrating thrombophlebitis was reported to Trusso in 1856. Additionally, it was noted that migratory thrombophlebitis is especially common in pancreatic tail cancer.

Thrombophlebitis of the superficial veins of the anterior chest wall and mammary gland

The so-called Mondor disease is a rare disease. Thrombophlebitis is usually located in the anterolateral lobe of the upper part of the breast. It can also be determined in the region starting from the lower part of the chest towards the costal edge and epigastrium.

A characteristic symptom of Mondor's disease is a cord-like phlebitis, which is best determined by pulling the skin while raising the arm.

The cause of Mondor's disease is unknown, but it is often associated with breast cancer. Similar pathology is also common after breast surgery, with the use of oral contraceptives, and protein C deficiency.

Superficial thrombophlebitis: symptoms

Symptoms of superficial venous thrombophlebitis are somewhat different from deep venous thrombophlebitis. The signs and symptoms of superficial venous thrombophlebitis primarily include:

  • Feeling of a hard cord in the area of ​​the affected vein
  • Soreness in this area, redness and feeling warm over a vein
  • The appearance of edema at the site of injury
  • Pain in limbs

With deep venous thrombophlebitis (DVT), as opposed to superficial, there may be no signs or symptoms of the disease. Sometimes sudden edema of the limb, pain in the affected area, local temperature rise are detected. Also in severe cases, there may be a change in skin color.

Video: Superficial Thrombophlebitis: Causes, Diagnosis, Symptoms, Treatment, Prognosis

Acute Superficial Thrombophlebitis

Acute superficial thrombophlebitis is a disease of the venous system. With the development of pathology, small blood clots can be found in the vessel lumen, despite the intact intima tunic. Often it develops again against the background of superficial varicose veins, which affects the superficial veins of the limb.

Clinically manifested seal small veins. The skin at the site of injury appears red with a burning sensation. Inflammation is locally associated with pain and hypersensitivity. In some patients, local fever, pigmentation, edema, and other inflammatory reactions may be detected. Also, the general condition of the patient is often associated with fever, headache and other systemic manifestations that seriously affect the work and well-being.

Acute superficial thrombophlebitis has always been considered a benign, self-limiting disease. According to Virhov, the causes of the development of acute superficial thrombophlebitis are as follows:

  1. Change in blood components
  2. Abnormal circulation
  3. Violation of the walls of blood vessels

Timely treatment of superficial thrombophlebitis helps to quickly get rid of pain and redness of the skin. As a rule, several weeks are enough for complete recovery. However, if there is any suspicion of a complication, you should immediately consult a doctor.

Combinations with other diseases:

  • Often simultaneously develops with deep vein thrombosis (in 6–53% of cases).
  • Symptomatic pulmonary embolism can also be observed simultaneously with PTF (0–10%).
  • Both pathologies (PTF and pulmonary thromboembolism) can occur 3 months after the onset of phlebitis.

Superficial thrombophlebitis: treatment

Superficial thrombophlebitis is treated by lifting the affected limb with anti-inflammatory drugs, such as ibuprofen, with mild anesthetics. If necessary, use warm, moist, well-absorbed means, either with continuous exposure, or with application every 4-6 hours if necessary.

If necessary, a short course of low molecular weight heparin (LMWH), Lovenox or Fondaparinux can be given. If PTF is combined with autoimmune syndrome or vasculitis, then corticosteroids can be used.

If there is a catheter or dropper, then most likely, they will have to be abandoned, since they most often cause thrombophlebitis. Antibiotics are used if there are signs of infection. In addition, in some cases, surgical correction of superficial venous insufficiency is performed.

Superficial thrombophlebitis of the lower extremities: treatment

Treatment aims to relieve local symptoms and prevent the thrombotic clot from entering deep veins. Also of importance is the prevention of relapse of PTF or the development of a more serious disease such as thromboembolism of the pulmonary artery.

To reduce discomfort and swelling, the doctor may recommend:

  • Wear compression underwear
  • Keep affected leg above heart level
  • Put a warm compress on the affected area

Medications called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be prescribed to reduce pain and swelling.

It is important to know that NSAIDs are contraindicated during pregnancy.

If there are additional clots in the deep veins, the doctor may prescribe medications to thin the blood. These drugs are called anticoagulants and their use is most often carried out under the control of a blood test. Violation of the dosage can lead to complications in the form of bleeding.

According to indications, surgical removal (phlebectomy), stripping or sclerotherapy of the affected vein is performed. With their help, they treat large varicose veins or prevent further development of thrombophlebitis in people at high risk. In the case of acute superficial thrombophlebitis, especially when it spreads up toward the inguinal region through the great saphenous vein. Then a Troyanova-Trendelenburg operation or a crosssectomy is performed (a large saphenous vein is tied up or cut in the groin area).

Superficial thrombophlebitis: photo

A 42-year-old patient was diagnosed with acute ascending thrombophlebitis in the thigh and shin areas. In order to improve the condition of the patient, treatment with RFO was performed. The photo shows a view of the lower limb before surgery, a week after it, and one month later.

A 70-year-old woman with anemia, asthma and glaucoma in history was referred to the hospital for erythema of the right leg, which could not be improved with antibiotics. She had leukocytosis of up to 325.8 c / l. Physical examination revealed an erythematous cord with significant pain along the left medial ankle. The right lower limb had a serpiginous strip along the side and back of the knee to the ankle. The pigmentation strips extended laterally from this longitudinal axis. Venous duplex scanning of the lower limbs was found to be “negative.” After leukophoresis and early treatment with tretinoin, she suffered a cerebrovascular accident.

A 80-year-old woman with hypertension, peripheral neuropathy and previous pulmonary artery thromboembolism was referred to a hospital with erythema of the lower extremities, leukocytosis and no improvement after cephalexin treatment. Physical examination revealed a linear serpentine erythema above the right arm, the left medial thigh and diffusely over the left medial tibia. Venous duplex scanning turned out to be “negative.” Flow cytometry and bone marrow biopsy confirmed hypogranular myeloid leukemia. As a result, decitabine treatment was started. This was followed by clinical resolution of thrombophlebitis.

A 50-year-old man was admitted to the emergency room with a fever and a rash on his left leg. Although the venous duplex scan was “negative,” leukopenia (2.1 cells / l), thrombocytopenia (3.6 cells / l) and nucleated red blood cells were found. A smear of peripheral blood showed blasts, the presence of Auer’s rods and tear-drop cells, which indicates acute myelogenous leukemia.

Acute ascending thrombophlebitis of the great saphenous vein on the left

Superficial thrombophlebitis of the lower extremities.

Prognosis and complications

Often, superficial thrombophlebitis is short-lived, and when performing medical recommendations it does not cause complications. Symptoms usually pass in 1-2 weeks. Feeling the hardness of a vein can last much longer.

  • Geriatric assumptions

Septic thrombophlebitis is more common. Predictive conclusion worse.

  • Pediatric assumptions

operiosteal abscesses of the closely located long bone may complicate superficial thrombophlebitis.

  • Pregnancy

During pregnancy there is an increased risk of developing aseptic superficial thrombophlebitis, especially in the postpartum period.

Possible complications

Complications are rare. Possible problems may include the following:

  • Infectious lesion surrounding tissue vessel
  • Deep vein thrombosis

An estimated 20% -33% of cases of SVT, almost one-third, are complicated by an asymptomatic pulmonary embolism, while 2% -13% are associated with a life-threatening symptomatic pulmonary embolism.

When to seek medical care?

If symptoms of superficial thrombophlebitis appear, you need to make an appointment with your doctor without delay.

You also need to call the doctor if even with the treatment of the disease, the condition and symptoms worsen or there is no noticeable improvement.

Prevention

In the hospital, swelling or inflammation of the veins can be prevented in the following ways:

  1. The nurse regularly changes the location of the intravenous needle and removes it when swelling, redness or pain occurs.
  2. It is important to walk and restore physical activity as soon as possible after surgery or during a long illness.
  3. Whenever possible, you should try not to keep your legs and arms still for a long time. It is useful to move your legs frequently or, if possible, to walk during long trips on an airplane or in a car.

It should be remembered that it is important to try not to sit and not lie down for a long time, without getting up or moving. Thus, hypodynamia primarily contributes to the development of superficial thrombophlebitis.

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