Superficial thrombophlebitis

Question 1

Define superficial thrombophlebitis

Answer 1

inflammation and thrombus formation in a superficial vein

Question 2

Aetiology of superficial thrombophlebitis

Answer 2

Most often occurs in the saphenous vein and its tributaries of the lower limbs
Can also occur in the veins of the upper limbs or neck, from intravenous cannulation and drug administration

Question 3

Risk factors for superficial thrombophlebitis

Answer 3

Varicose veins
Thrombophilia
Autoimmune disease e.g. Behcet’s, Buerger’s disease
Previous history
IV injection/cannulation
Cancer
Pregnancy/post-partum
Female
Older
Immobile
OCP, HRT
Obesity

Question 4

Clinical features of superficial thrombophlebitis

Answer 4

Inflammation (pain, erythema, swelling, etc.)
Recent vein instrumentation (i.e. sclerotherapy) or IV access
Varicose veins
Palpable/nodular cord

Question 5

Differentials for superficial thrombophlebitis

Answer 5

DVT
Cellulitis
Chronic venous insufficiency
Insect bite/sting
Lymphangitis
Tendonitis
Erythema nodosum
Polyarteritis nodosum

Question 6

Investigations for superficial thrombophlebitis

Answer 6

Doppler US (?DVT)
ABPI (?arterial insufficiency)

Question 7

Management for superficial thrombophlebitis

Answer 7

Conservative:
Warm, moist toile applied to the limb
Keep leg elevated
Continue to be mobile and use the affected limb

Medical:
<5cm + >3cm from saphenofemoral junction → NSAIDs (topical or oral)
>5cm + >3cm from SFJ → fondaparinux, LMWH, rivaroxaban
<3cm from SFJ → therapeutic anticoagulation

Recurrent → Varicose vein surgery ± prophylactic LMWH
SFJ ligation

Question 8

Complications and prognosis of superficial thrombophlebitis

Answer 8

DVT
Infection - septic thrombophlebitis
Hyperpigmentation
Subcutaneous nodules
Varicose veins

Uncomplicated superficial vein thrombosis is generally considered to be a benign and self-limiting condition, and symptoms generally subside in 1–2 weeks, although hardness of the vein may persist for longer (several weeks to months).