Superficial Thrombophlebitis

Inflammation associated with a thrombosed superficial vein.

In > 90% of cases, superficial thrombophlebitis occurs in varicose veins. Stasis within these incompetent veins leads to clotting.

Symptoms, Signs, and Diagnosis

Superficial thrombophlebitis is a more inflammatory process than is deep vein thrombosis. The usual presenting symptom is pain. Physical examination reveals an area of erythema, warmth, and tenderness overlying a palpable venous cord. Often, many areas of thrombosis occur along the course of a superficial vein.

Superficial thrombophlebitis, especially if below the knee, is usually a self-limited process, and signs of inflammation usually fade within 5 to 10 days. There may be no residual effects, or a nontender cord, representing a permanently thrombosed vein, may remain. Superficial thrombophlebitis rarely leads to pulmonary embolism. However, pulmonary embolism can occur if a clot propagates into the femoral vein as a result of thrombophlebitis of the great saphenous vein spreading toward the inguinal area.

If thrombophlebitis occurs in veins that are not dilated or if it is recurrent and migratory, the patient should be promptly evaluated for an occult neoplasm (especially pancreatic cancer), thrombocytosis, polycythemia, antithrombin III deficiency, collagen vascular disease, the presence of cryoproteins or lupus anticoagulant, protein C and S deficiencies, hyperhomocysteinemia, and protein C resistance.

Prophylaxis and Treatment

Stasis can be prevented with elastic bandages or stockings. For superficial thrombophlebitis below the knee, treatment consists of warm soaks, decreased ambulation, and a nonsteroidal anti-inflammatory drug. For superficial thrombophlebitis in the lower thigh, a short course of heparin may be useful while signs of inflammation are present. If the cord extends to the upper thigh, the great saphenous vein should be ligated at its most proximal point, using a local anesthetic.