Surface thrombophlebitis

Surface thrombophlebitis (STP) is a widespread and controversial condition, since the pathophysiology of thrombophlebitis and deep vein thrombosis (DVT) are closely interrelated.

Surface thrombophlebitis begins with discomfort in the legs, the vein becomes hot. In the course of the vein, the compaction is felt, as if a cord was stretched through it.

Numerous studies have described risk factors for the development of superficial thrombophlebitis, many of which coincide with DVT factors. Varicose veins in the lower limb in 93% of cases is the most common predisposing risk factor. Other factors include age, female sex, obesity, recent surgery or immobilization, hormonal effects, the presence of previous venous thromboembolism (VTE) and malignant neoplasms. Seasonal fluctuations also affect the development of the disease, the peak incidence is usually observed in the warm summer months.

Risk of complications

For patients over the age of 60 years, with DVT in history, recent immobilization and systemic infection, the chance of developing deep vein thrombosis and concomitant thrombophlebitis increases. Severe chronic venous insufficiency and sudden onset of superficial thrombophlebitis are statistically significant risk factors for the development of VTE.

Diagnostic approach

Surface thrombophlebitis is more common in patients with varicose veins, but may also occur in normal subcutaneous veins in patients with underlying thrombophilia. The prevalence of concomitant venous complications in patients with STP prescribes duplex scanning for each patient. The results of the study not only show the presence or absence of a thrombus, but also help in determining the complications. By results of US it is possible to tell or say it is required more extended researches by means of a tomography.

Treatment Options

The main goal of treating superficial thrombophlebitis is to prevent the expansion of blood clots and the risks of developing VTE. Many reference texts on vascular surgery and primary care continue to advertise bed rest within therapy for STP and DVT. Nevertheless, the recommendation for bed rest for patients with acute thrombosis contributes to venous stasis, which is a trigger for a thrombus. Randomized studies have shown that compression and walking are better than bed rest to reduce edema and discomfort, and to minimize the expansion of thrombi in patients with proximal DVT.

Compression therapy

Compression offers the most scientifically proven advantage for the therapy of superficial thrombophlebitis. It alleviates the symptoms, and is also a prophylaxis against the development of DVT. The Decousus study confirms that compression therapy using gradient compression stockings or leg wraps is the current standard of treatment for patients with STP. A general rule of thumb applies to the compression gradient, depending on the severity of venous insufficiency, skin changes and the presence of edema. The heavier the symptoms, the greater the degree of compression is shown.

Anticoagulation and anti-inflammatory therapy

The prevalence of concomitant pathologies and the risk of complications in acute superficial thrombosis led many researchers to use systemic anticoagulation. For example, low-molecular-weight heparin is recommended in preventive or intermediate doses for at least four weeks. Surface thrombosis can be controlled more conservatively, avoiding anticoagulation in favor of anti-inflammatory agents.

An acute inflammatory reaction is often observed with superficial phlebitis, and can cause fears of a potential infectious process. Patients with purulent thrombophlebitis require drainage and administration of broad-spectrum antibiotics.

Surgical intervention

In cases of acute inflammation, tenderness and fluctuations, a local incision and drainage is done. After cleaning and introducing local anesthesia, using a needle make punctures in altered places. This is a simple procedure, and after the punctures are done, the doctor can effectively expel the superficial thrombus. The procedure significantly reduces inflammation and pain, with the added benefit of reducing the risk of pronounced hyperpigmentation over the affected area.