Thrombophlebitis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(66 intermediate revisions by 6 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Thrombophlebitis}}
{{SI}}
'''For patient information, click [[Thrombophlebitis (patient information)|here]]'''
'''For patient information, click [[Thrombophlebitis (patient information)|here]]'''


{{CMG}}
{{CMG}}; {{AE}}{{DN}}


{{SK}} White Leg; phlebitis
{{SK}} White Leg; phlebitis
==[[Thrombophlebitis overview|Overview]]==
==Overview==
Thrombophlebitis is inflammation of a [[vein]], usually associated with the formation of a [[thrombus]] within the superficial venous system. It can occur in any superficial venous system, but most commonly in the [[lower limbs]]. Symptoms of thrombophlebitis include [[pain]] along the course of the [[vein]], [[redness]], [[itching]] and [[swelling]] around the site of thrombophlebitis. The treatment of thrombophlebitis consists of [[compression stockings]], [[analgesia]], as well as [[anticoagulants]]. The most feared complications are [[DVT]] and [[PE]]. 


==[[Thrombophlebitis historical perspective|Historical Perspective]]==
==[[Historical Perspective]]==
*In 1913, Burnham AC discussed thrombophlebitis in postoperative patients.<ref name="pmid17862964">{{cite journal |vauthors=Burnham AC |title=II. Postoperative Thrombophlebitis |journal=Ann. Surg. |volume=57 |issue=2 |pages=151–62 |year=1913 |pmid=17862964 |pmc=1407408 |doi= |url=}}</ref>
*Historically, the treatment of thrombophlebitis was purely [[Surgery|surgical]] and consisted of removal of the t[[Venous thrombosis|hrombosed vein]].<ref name="pmid17865873">{{cite journal |vauthors=Homans J |title=THROMBOPHLEBITIS OF THE LOWER EXTREMITIES |journal=Ann. Surg. |volume=87 |issue=5 |pages=641–51 |year=1928 |pmid=17865873 |pmc=1398549 |doi= |url=}}</ref>


==[[Thrombophlebitis pathophysiology|Pathophysiology]]==
==Classification==
Thrombophlebitis can be classified according to the cause into:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref>
{| class="wikitable"
!Type of Thrombophlebitis
!Description
|-
![[Sterile]]
|Most common type of thrombophlebitis
|-
!Traumatic
|Associated with the following conditions:
* [[Limb]] injury: associated with [[ecchymosis]] of the surrounding tissue
* [[IV]] [[cannulation]] and [[infusion]] of irritant products
* [[Sclerotherapy]]
|-
!Infective
|Mostly due to prolonged [[IV]] [[cannulation]]
|-
!Migratory
|Recurrent thrombophlebitis at various sites. Associated with an underlying [[malignancy]], most commonly [[adenocarcinoma]] of the [[pancreas]]
|}
Thrombophlebitis may also be classified according to the site into:<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref>
# Superficial thrombophlebitis of the [[lower limb]]: most common location and it involves the [[Great saphenous vein|great]] and [[Short saphenous vein|short saphenous veins]].
# Superficial thrombophlebitis of the [[Arm|arms]]
# Superficial thrombophlebitis of the [[breast]]: also known as [[Mondor's disease]]
# Superficial thrombophlebitis of the [[abdominal wall]]


==[[Thrombophlebitis causes|Causes]]==
==Pathophysiology==
===Pathogenesis===
The pathogenesis of thrombophlebitis is related to 3 important factors:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref><ref name="pmid8624665">{{cite journal |vauthors=Guex JJ |title=Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis |journal=Dermatol Surg |volume=22 |issue=4 |pages=378–82 |year=1996 |pmid=8624665 |doi= |url=}}</ref><ref name="pmid2195069">{{cite journal |vauthors=Samlaska CP, James WD |title=Superficial thrombophlebitis. II. Secondary hypercoagulable states |journal=J. Am. Acad. Dermatol. |volume=23 |issue=1 |pages=1–18 |year=1990 |pmid=2195069 |doi= |url=}}</ref>


==[[Thrombophlebitis differential diagnosis|Differentiating Thrombophlebitis from other Diseases]]==
*[[Venous stasis]]


==[[Thrombophlebitis epidemiology and demographics|Epidemiology and Demographics]]==
*[[Hypercoagulability]] of [[blood]]


==[[Thrombophlebitis risk factors|Risk Factors]]==
*[[Trauma]] to [[veins]]


==[[Thrombophlebitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
These 3 factors (known as [[Virchow's triad]]) predispose to [[thrombus]] formation within the [[Vein|veins]] and subsequently to thrombophlebitis.
 
===Associated Conditions===
Thrombophlebitis may be associated with the following conditions:
*[[Coagulation disorders|Coagulation abnormalities]]:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref><ref name="pmid10544900">{{cite journal |vauthors=Martinelli I, Cattaneo M, Taioli E, De Stefano V, Chiusolo P, Mannucci PM |title=Genetic risk factors for superficial vein thrombosis |journal=Thromb. Haemost. |volume=82 |issue=4 |pages=1215–7 |year=1999 |pmid=10544900 |doi= |url=}}</ref>
**[[Factor V Leiden mutation]]
**[[Prothrombin G20210A mutation]]
**[[Protein C deficiency]]
**[[Protein S deficiency]]
**[[Antithrombin III deficiency]]
*[[Thromboangiitis obliterans]] ([[Buerger's disease|Buerger's Disease]])<ref name="pmid10995867">{{cite journal |vauthors=Olin JW |title=Thromboangiitis obliterans (Buerger's disease) |journal=N. Engl. J. Med. |volume=343 |issue=12 |pages=864–9 |year=2000 |pmid=10995867 |doi=10.1056/NEJM200009213431207 |url=}}</ref>
*Underlying [[malignancy]], especially [[pancreatic adenocarcinoma|adenocarcinoma of the pancreas]] in the case of migratory thrombophlebitis<ref name="pmid20302205">{{cite journal |vauthors=Diaconu C, Mateescu D, Bălăceanu A, Marcu M, Jianu V, Stănică A |title=Pancreatic cancer presenting with paraneoplastic thrombophlebitis--case report |journal=J Med Life |volume=3 |issue=1 |pages=96–9 |year=2010 |pmid=20302205 |pmc=3019029 |doi= |url=}}</ref><ref name="pmid17496204">{{cite journal |vauthors=Varki A |title=Trousseau's syndrome: multiple definitions and multiple mechanisms |journal=Blood |volume=110 |issue=6 |pages=1723–9 |year=2007 |pmid=17496204 |pmc=1976377 |doi=10.1182/blood-2006-10-053736 |url=}}</ref>
 
==Causes==
<div style="-webkit-user-select: none;">
===Common Causes===
*[[Deep vein thrombosis]]
*Drug side effects
*[[Intravenous infusion]]
*[[IV]] [[catheter]] [[infection]]
*[[Levamisole|Levamisole-induced]] [[vasculopathy]]
*[[Penicillin G|Penicillin G potassium infusion]]
*[[Thromboangiitis obliterans]]
*[[Thrombophlebitis migrans]]
*[[Varicose veins]]
*[[Vein]] injury
 
==Differentiating Thrombophlebitis from other Diseases==
Thrombophlebitis must be differentiated from the following conditions causing [[pain]], [[swelling]] and [[Mass|palpapable mass]] in the [[extremities]]:<ref name="pmid24182642">{{cite journal| author=Cohen AT, Dobromirski M, Gurwith MM| title=Managing pulmonary embolism from presentation to extended treatment. | journal=Thromb Res | year= 2014 | volume= 133 | issue= 2 | pages= 139-48 | pmid=24182642 | doi=10.1016/j.thromres.2013.09.040 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24182642  }} </ref><ref name="pmid27271418">{{cite journal |vauthors=Füeßl HS |title=[Emergency checklist: Acute lymphangitis] |language=German |journal=MMW Fortschr Med |volume=158 |issue=11 |pages=65 |year=2016 |pmid=27271418 |doi=10.1007/s15006-016-8384-9 |url=}}</ref><ref name="pmid27051706">{{cite journal |vauthors=Chung E, Pulitzer MP, Papadopoulos EB, Papanicolaou GA, Babady NE, Marchetti MA |title=Lymphangitic papules caused by Nocardia takedensis |journal=JAAD Case Rep |volume=1 |issue=3 |pages=126–8 |year=2015 |pmid=27051706 |pmc=4808715 |doi=10.1016/j.jdcr.2015.03.001 |url=}}</ref><ref name="lymphangitis">lymphangitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016</ref>
<div style="width: 85%;">
 
{| class="wikitable"
!Condition
!Predilection Site
!Pain
!Redness
!Warmth
!Swelling of Surrounding Tissue
!Itching
!Palpable Mass
!Systemic Symptoms
|-
|[[Varicose veins]]
|[[Lower limb]]
| +
| -
| -
| +
| +
| -
| -
|-
|[[Deep vein thrombosis]]
|[[Lower limb]]
| +
| +
| +
| +
| -
| -
|Systemic symptoms are present if [[DVT]] is complicated by [[PE]]. These include:
* [[Fever]]
* [[Cough]]
* [[Shortness of breath]]
|-
|[[Cellulitis]]
|No sites of predilection
| +
| +
| +
| +
| -
|<nowiki>-</nowiki>
|
* [[Fever]]
* [[Chills]]
* [[Sweating]]
* [[Fatigue]]
|-
|[[Lymphangitis]]
|Commonly the [[extremities]]
| +
| +
|<nowiki>-</nowiki>
| +
| -
| -
|May be accompanied by:
* [[Chills]]
* [[Malaise]]
* [[Myalgia]]
* [[Headache]]
|-
|[[Lymphedema]]
|[[Lower limb]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Fever]]
* [[Chills]]
* [[Fatigue]]
|-
|[[Baker's cyst]]
|[[Lower limb]]
| +/-
| -
| -
| +
| -
|Sensation of a water-filled balloon on the [[posterior]] aspect of the [[knee]] and [[Calf muscle|calf]]
| -
|-
|[[Polyarteritis nodosa]]
|[[Cutaneous]] [[Polyarteritis nodosa|PAN]] most commonly involves
the [[lower limb]]
| +
| -
| -
| -
| -
|[[Nodules]]
|
* [[Fever]]
* [[Fatigue]]
* [[Myalgia]]
* [[Arthralgia]]
* [[Weight loss]]
|-
|[[Gastrocnemius rupture|Ruptured medial head of gastrocnemius]]
|[[Lower limb]]
| +
| -
| -
| +
| -
|Painful lump at the site of rupture
| -
|}
</div>
 
==Epidemiology and Demographics==
===Epidemiology===
====[[Incidence]]====
*The [[incidence]] of thrombophlebitis is estimated at 100 per 100,000 cases.<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref><ref name="pmid23633322">{{cite journal |vauthors=Di Nisio M, Wichers IM, Middeldorp S |title=Treatment for superficial thrombophlebitis of the leg |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004982 |year=2013 |pmid=23633322 |doi=10.1002/14651858.CD004982.pub5 |url=}}</ref>
*Thrombophlebitis is 6 times more common than [[DVT]].<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref>
 
===Demographics===
====Age====
*Thrombophlebitis is more common in elderly.<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref>
 
==Risk Factors==
The following are associated with an increased risk of thrombophlebitis:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref><ref name="pmid8624665">{{cite journal |vauthors=Guex JJ |title=Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis |journal=Dermatol Surg |volume=22 |issue=4 |pages=378–82 |year=1996 |pmid=8624665 |doi= |url=}}</ref><ref name="pmid2195069">{{cite journal |vauthors=Samlaska CP, James WD |title=Superficial thrombophlebitis. II. Secondary hypercoagulable states |journal=J. Am. Acad. Dermatol. |volume=23 |issue=1 |pages=1–18 |year=1990 |pmid=2195069 |doi= |url=}}</ref><ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref>
*[[Chronic venous disease]], such as [[varicose veins]] (most common risk factor)<ref name="pmid15738838">{{cite journal |vauthors=Gillet JL, Allaert FA, Perrin M |title=[Superficial thrombophlebitis in non varicose veins of the lower limbs. A prospective analysis in 42 patients] |language=French |journal=J Mal Vasc |volume=29 |issue=5 |pages=263–72 |year=2004 |pmid=15738838 |doi= |url=}}</ref><ref name="pmid15906904">{{cite journal |vauthors=De Maeseneer MG |title=Superficial thrombophlebitis of the lower limb: practical recommendations for diagnosis and treatment |journal=Acta Chir. Belg. |volume=105 |issue=2 |pages=145–7 |year=2005 |pmid=15906904 |doi= |url=}}</ref> and [[chronic venous insufficiency]]
*[[Venous]] [[thrombosis]], whether a prior history or current [[DVT]]<ref name="pmid8624665">{{cite journal |vauthors=Guex JJ |title=Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis |journal=Dermatol Surg |volume=22 |issue=4 |pages=378–82 |year=1996 |pmid=8624665 |doi= |url=}}</ref>
*[[Venous stasis]], associated with prolonged [[immobility]] and prolonged [[surgery]]
*[[Hypercoagulable states]], such as [[malignancy]]<ref name="pmid15738838">{{cite journal |vauthors=Gillet JL, Allaert FA, Perrin M |title=[Superficial thrombophlebitis in non varicose veins of the lower limbs. A prospective analysis in 42 patients] |language=French |journal=J Mal Vasc |volume=29 |issue=5 |pages=263–72 |year=2004 |pmid=15738838 |doi= |url=}}</ref>, [[pregnancy]] and the use of [[estrogen]]-based [[hormone therapy]]<ref name="pmid9364982">{{cite journal |vauthors=McColl MD, Ramsay JE, Tait RC, Walker ID, McCall F, Conkie JA, Carty MJ, Greer IA |title=Risk factors for pregnancy associated venous thromboembolism |journal=Thromb. Haemost. |volume=78 |issue=4 |pages=1183–8 |year=1997 |pmid=9364982 |doi= |url=}}</ref>
*[[Trauma]] to the [[Blood vessel|vessel]], such as [[IV]] [[cannulation]], [[sclerotherapy]] and surgical [[ablation]]
*[[Obesity]]
 
==Natural History, Complications and Prognosis==
 
===Natural History===
Thrombophlebitis was thought of as a benign condition. However, if left untreated, thrombophlebitis can recur or extend to involve the [[Deep vein|deep venous system]]. [[DVT]] can still complicate 10% of cases, despite treatment.<ref name="pmid24549553">{{cite journal |vauthors=Di Nisio M, Middeldorp S |title=Treatment of lower extremity superficial thrombophlebitis |journal=JAMA |volume=311 |issue=7 |pages=729–30 |year=2014 |pmid=24549553 |doi=10.1001/jama.2014.520 |url=}}</ref>
 
===Complications===
Complications of thrombophlebitis include:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref><ref name="pmid1866693">{{cite journal |vauthors=Lutter KS, Kerr TM, Roedersheimer LR, Lohr JM, Sampson MG, Cranley JJ |title=Superficial thrombophlebitis diagnosed by duplex scanning |journal=Surgery |volume=110 |issue=1 |pages=42–6 |year=1991 |pmid=1866693 |doi= |url=}}</ref><ref name="pmid8918318">{{cite journal |vauthors=Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ |title=Progression of superficial venous thrombosis to deep vein thrombosis |journal=J. Vasc. Surg. |volume=24 |issue=5 |pages=745–9 |year=1996 |pmid=8918318 |doi= |url=}}</ref><ref name="pmid3081214">{{cite journal |vauthors=Bergqvist D, Jaroszewski H |title=Deep vein thrombosis in patients with superficial thrombophlebitis of the leg |journal=Br Med J (Clin Res Ed) |volume=292 |issue=6521 |pages=658–9 |year=1986 |pmid=3081214 |pmc=1339644 |doi= |url=}}</ref><ref name="pmid28116936">{{cite journal |vauthors=Sándor T |title=[Superficial venous thrombosis. A state of art] |language=Hungarian |journal=Orv Hetil |volume=158 |issue=4 |pages=129–138 |year=2017 |pmid=28116936 |doi=10.1556/650.2017.30618 |url=}}</ref>
*[[Venous thromboembolism]] and subsequent [[pulmonary embolism]]: this is especially common when superficial thrombophlebitis occurs at the junction with the [[Deep vein|deep venous system]]<ref name="pmid9510288">{{cite journal |vauthors=Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J |title=Occult deep venous thrombosis complicating superficial thrombophlebitis |journal=J. Vasc. Surg. |volume=27 |issue=2 |pages=338–43 |year=1998 |pmid=9510288 |doi= |url=}}</ref><ref name="pmid9576081">{{cite journal |vauthors=Hanson JN, Ascher E, DePippo P, Lorensen E, Scheinman M, Yorkovich W, Hingorani A |title=Saphenous vein thrombophlebitis (SVT): a deceptively benign disease |journal=J. Vasc. Surg. |volume=27 |issue=4 |pages=677–80 |year=1998 |pmid=9576081 |doi= |url=}}</ref><ref name="pmid10587397">{{cite journal |vauthors=Verlato F, Zucchetta P, Prandoni P, Camporese G, Marzola MC, Salmistraro G, Bui F, Martini R, Rosso F, Andreozzi GM |title=An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh |journal=J. Vasc. Surg. |volume=30 |issue=6 |pages=1113–5 |year=1999 |pmid=10587397 |doi= |url=}}</ref><ref name="pmid20860504">{{cite journal |vauthors=Decousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G, Leizorovicz A |title=Fondaparinux for the treatment of superficial-vein thrombosis in the legs |journal=N. Engl. J. Med. |volume=363 |issue=13 |pages=1222–32 |year=2010 |pmid=20860504 |doi=10.1056/NEJMoa0912072 |url=}}</ref><ref name="pmid2098372">{{cite journal |vauthors=Belcaro G |title=Evolution of superficial vein thrombosis treated with defibrotide: comparison with low dose subcutaneous heparin |journal=Int J Tissue React |volume=12 |issue=5 |pages=319–24 |year=1990 |pmid=2098372 |doi= |url=}}</ref><ref name="pmid10431991">{{cite journal |vauthors=Belcaro G, Nicolaides AN, Errichi BM, Cesarone MR, De Sanctis MT, Incandela L, Venniker R |title=Superficial thrombophlebitis of the legs: a randomized, controlled, follow-up study |journal=Angiology |volume=50 |issue=7 |pages=523–9 |year=1999 |pmid=10431991 |doi= |url=}}</ref>
*[[Hyperpigmentation]] of the [[skin]] overlying the affected [[vein]]
*[[Infection]] and [[abscess]] formation
 
===Prognosis===
The prognosis of thrombophlebitis is generally good with [[medical treatment]]. However, despite treatment, [[DVT]] can complicate about 10% of cases of thrombophlebitis.
 
==Screening==
There are no screening recommendations for thrombophlebitis.<ref name="USPSTF"> U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=thrombophlebitis. Accessed on Feb. 15, 2017</ref>


==Diagnosis==
==Diagnosis==
[[Thrombophlebitis history and symptoms|History and Symptoms]] | [[Thrombophlebitis physical examination|Physical Examination]] | [[Thrombophlebitis laboratory findings|Laboratory Findings]] | [[Thrombophlebitis ultrasound|Ultrasound]] | [[Thrombophlebitis other imaging findings|Other Imaging Findings]] | [[Thrombophlebitis other diagnostic studies|Other Diagnostic Studies]]
===History and Symptoms===
The following symptoms are often (but not always) present in patients with thrombophlebitis:<ref name="pmid26047909">{{cite journal |vauthors=Gizurarson JG, Filippusson H |title=Conjugation of D-glucosamine to bovine trypsin increases thermal stability and alters functional properties |journal=Enzyme Microb. Technol. |volume=75-76 |issue= |pages=1–9 |year=2015 |pmid=26047909 |doi=10.1016/j.enzmictec.2015.04.005 |url=}}</ref><ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref><ref name="pmid23633322">{{cite journal |vauthors=Di Nisio M, Wichers IM, Middeldorp S |title=Treatment for superficial thrombophlebitis of the leg |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004982 |year=2013 |pmid=23633322 |doi=10.1002/14651858.CD004982.pub5 |url=}}</ref>
*[[Pain]] along the course of the affected [[vein]]
*[[Pain]] on touch of the affected [[vein]] ([[tenderness]])
*[[Skin]] redness ([[erythema]])
*[[Itching]]
*[[Swelling]] of the surrounding [[tissue]] ([[edema]])
*[[fever|Elevated temperature (fever)]] may or may not be present
 
===Physical Examination===
Examination of the [[skin]] and affected area reveals the following:<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref><ref name="pmid23633322">{{cite journal |vauthors=Di Nisio M, Wichers IM, Middeldorp S |title=Treatment for superficial thrombophlebitis of the leg |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004982 |year=2013 |pmid=23633322 |doi=10.1002/14651858.CD004982.pub5 |url=}}</ref><ref name="pmid26047909">{{cite journal |vauthors=Gizurarson JG, Filippusson H |title=Conjugation of D-glucosamine to bovine trypsin increases thermal stability and alters functional properties |journal=Enzyme Microb. Technol. |volume=75-76 |issue= |pages=1–9 |year=2015 |pmid=26047909 |doi=10.1016/j.enzmictec.2015.04.005 |url=}}</ref>
* [[Tenderness]] along the course of the affected [[vein]]
* [[Erythema]] of the [[skin]] surrounding the [[vein]]
* [[Edema]] of the surrounding [[tissue]]
 
===Laboratory Findings===
====D-Dimer====
[[D-dimer|D-Dimer]] is not a useful laboratory test in the diagnosis of isolated cases of superficial thrombophlebitis. However, it may be useful in the case of a concomitant [[DVT]].<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref>
 
===[[Ultrasound]]===
====[[Venous]] [[Duplex ultrasound|Duplex Ultrasound]]====
Although the diagnosis of thrombophlebitis is mostly clinical, [[venous]] [[Duplex ultrasound]] is considered the imaging of choice in suspected cases.<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref><ref name="pmid28116936">{{cite journal |vauthors=Sándor T |title=[Superficial venous thrombosis. A state of art] |language=Hungarian |journal=Orv Hetil |volume=158 |issue=4 |pages=129–138 |year=2017 |pmid=28116936 |doi=10.1556/650.2017.30618 |url=}}</ref> [[Venous]] [[Duplex ultrasound]] can identify the following:
*Thickening of the wall of the [[vein]], which may be associated with perivenous or [[subcutaneous]] [[edema]]
*A [[thrombus]] may or may not be present within the [[Superficial veins|superficial venous system]]<ref name="pmid1866693">{{cite journal |vauthors=Lutter KS, Kerr TM, Roedersheimer LR, Lohr JM, Sampson MG, Cranley JJ |title=Superficial thrombophlebitis diagnosed by duplex scanning |journal=Surgery |volume=110 |issue=1 |pages=42–6 |year=1991 |pmid=1866693 |doi= |url=}}</ref>
*[[DVT]] may exist along with superficial thrombophlebitis, especially when thrombophlebitis involves the proximal [[great saphenous vein]]<ref name="pmid8624665">{{cite journal |vauthors=Guex JJ |title=Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis |journal=Dermatol Surg |volume=22 |issue=4 |pages=378–82 |year=1996 |pmid=8624665 |doi= |url=}}</ref><ref name="pmid9510288">{{cite journal |vauthors=Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J |title=Occult deep venous thrombosis complicating superficial thrombophlebitis |journal=J. Vasc. Surg. |volume=27 |issue=2 |pages=338–43 |year=1998 |pmid=9510288 |doi= |url=}}</ref><ref name="pmid19620555">{{cite journal |vauthors=Binder B, Lackner HK, Salmhofer W, Kroemer S, Custovic J, Hofmann-Wellenhof R |title=Association between superficial vein thrombosis and deep vein thrombosis of the lower extremities |journal=Arch Dermatol |volume=145 |issue=7 |pages=753–7 |year=2009 |pmid=19620555 |doi=10.1001/archdermatol.2009.123 |url=}}</ref><ref name="pmid9290540">{{cite journal |vauthors=Bounameaux H, Reber-Wasem MA |title=Superficial thrombophlebitis and deep vein thrombosis. A controversial association |journal=Arch. Intern. Med. |volume=157 |issue=16 |pages=1822–4 |year=1997 |pmid=9290540 |doi= |url=}}</ref><ref name="pmid1866693">{{cite journal |vauthors=Lutter KS, Kerr TM, Roedersheimer LR, Lohr JM, Sampson MG, Cranley JJ |title=Superficial thrombophlebitis diagnosed by duplex scanning |journal=Surgery |volume=110 |issue=1 |pages=42–6 |year=1991 |pmid=1866693 |doi= |url=}}</ref><ref name="pmid3081214">{{cite journal |vauthors=Bergqvist D, Jaroszewski H |title=Deep vein thrombosis in patients with superficial thrombophlebitis of the leg |journal=Br Med J (Clin Res Ed) |volume=292 |issue=6521 |pages=658–9 |year=1986 |pmid=3081214 |pmc=1339644 |doi= |url=}}</ref><ref name="pmid9576081">{{cite journal |vauthors=Hanson JN, Ascher E, DePippo P, Lorensen E, Scheinman M, Yorkovich W, Hingorani A |title=Saphenous vein thrombophlebitis (SVT): a deceptively benign disease |journal=J. Vasc. Surg. |volume=27 |issue=4 |pages=677–80 |year=1998 |pmid=9576081 |doi= |url=}}</ref><ref name="pmid2031032">{{cite journal |vauthors=Messmore HL, Bishop M, Wehrmacher WH |title=Acute venous thrombosis. Therapeutic choices for superficial and deep veins |journal=Postgrad Med |volume=89 |issue=7 |pages=73–7 |year=1991 |pmid=2031032 |doi= |url=}}</ref><ref name="pmid2193177">{{cite journal |vauthors=Skillman JJ, Kent KC, Porter DH, Kim D |title=Simultaneous occurrence of superficial and deep thrombophlebitis in the lower extremity |journal=J. Vasc. Surg. |volume=11 |issue=6 |pages=818–23; discussion 823–4 |year=1990 |pmid=2193177 |doi= |url=}}</ref><ref name="pmid8918318">{{cite journal |vauthors=Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ |title=Progression of superficial venous thrombosis to deep vein thrombosis |journal=J. Vasc. Surg. |volume=24 |issue=5 |pages=745–9 |year=1996 |pmid=8918318 |doi= |url=}}</ref><ref name="pmid10587397">{{cite journal |vauthors=Verlato F, Zucchetta P, Prandoni P, Camporese G, Marzola MC, Salmistraro G, Bui F, Martini R, Rosso F, Andreozzi GM |title=An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh |journal=J. Vasc. Surg. |volume=30 |issue=6 |pages=1113–5 |year=1999 |pmid=10587397 |doi= |url=}}</ref>
*Ruling out other pathologies such as a [[popliteal cyst]] or [[muscle]] mass, which may be responsible for the patient's complaints<ref name="pmid22832262">{{cite journal |vauthors=Quéré I, Leizorovicz A, Galanaud JP, Presles E, Barrellier MT, Becker F, Desprairies G, Guenneguez H, Mismetti P, Décousus H |title=Superficial venous thrombosis and compression ultrasound imaging |journal=J. Vasc. Surg. |volume=56 |issue=4 |pages=1032–8.e1 |year=2012 |pmid=22832262 |doi=10.1016/j.jvs.2012.03.014 |url=}}</ref><ref name="pmid23181477">{{cite journal |vauthors=Ellis MH, Fajer S |title=A current approach to superficial vein thrombosis |journal=Eur. J. Haematol. |volume=90 |issue=2 |pages=85–8 |year=2013 |pmid=23181477 |doi=10.1111/ejh.12044 |url=}}</ref>
 
===Other Imaging Findings===
There are no other imaging findings associated with thrombophlebitis.
 
===Other Diagnostic Studies===
There are no other diagnostic studies associated with thrombophlebitis.


==Treatment==
==Treatment==
[[Thrombophlebitis medical therapy|Medical Therapy]] | [[Thrombophlebitis surgery|Surgery]] | [[Thrombophlebitis primary prevention|Primary Prevention]] | [[Thrombophlebitis secondary prevention|Secondary Prevention]] | [[Thrombophlebitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Thrombophlebitis future or investigational therapies|Future or Investigational Therapies]]
===Medical Therapy===
The following interventions are used as a mainstay in treatment of thrombophlebitis:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref><ref name="pmid24549553">{{cite journal |vauthors=Di Nisio M, Middeldorp S |title=Treatment of lower extremity superficial thrombophlebitis |journal=JAMA |volume=311 |issue=7 |pages=729–30 |year=2014 |pmid=24549553 |doi=10.1001/jama.2014.520 |url=}}</ref><ref name="pmid18512540">{{cite journal |vauthors=Blättler W, Schwarzenbach B, Largiadèr J |title=Superficial vein thrombophlebitis--serious concern or much ado about little? |journal=VASA |volume=37 |issue=1 |pages=31–8 |year=2008 |pmid=18512540 |doi=10.1024/0301-1526.37.1.31 |url=}}</ref><ref name="pmid28116936">{{cite journal |vauthors=Sándor T |title=[Superficial venous thrombosis. A state of art] |language=Hungarian |journal=Orv Hetil |volume=158 |issue=4 |pages=129–138 |year=2017 |pmid=28116936 |doi=10.1556/650.2017.30618 |url=}}</ref>
 
====[[Non-steroidal anti-inflammatory drug|Nonsteroidal Anti-Inflammatory Drugs]]====
All [[NSAIDs]] have the same effect in the treatment of thrombophlebitis.<ref name="Di Nisio-2013">{{Cite journal  | last1 = Di Nisio | first1 = M. | last2 = Wichers | first2 = IM. | last3 = Middeldorp | first3 = S. | title = Treatment for superficial thrombophlebitis of the leg. | journal = Cochrane Database Syst Rev | volume = 4 | issue =  | pages = CD004982 | month =  | year = 2013 | doi = 10.1002/14651858.CD004982.pub5 | PMID = 23633322 }}</ref>  They are effective in reducing the [[pain]], and decrease the extension of [[thrombosis]].<ref name="-2003">{{Cite journal  | title = A pilot randomized double-blind comparison of a low-molecular-weight heparin, a nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial vein thrombosis. | journal = Arch Intern Med | volume = 163 | issue = 14 | pages = 1657-63 | month = Jul | year = 2003 | doi = 10.1001/archinte.163.14.1657 | PMID = 12885680 }}</ref><ref name="pmid23633322">{{cite journal |vauthors=Di Nisio M, Wichers IM, Middeldorp S |title=Treatment for superficial thrombophlebitis of the leg |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004982 |year=2013 |pmid=23633322 |doi=10.1002/14651858.CD004982.pub5 |url=}}</ref>
 
====[[Anticoagulant|Anticoagulation]]====
*Unlike minimal thrombophlebitis that can be resolved using conservative measures and [[NSAIDs]], severe cases need [[anticoagulation therapy]] to prevent [[thrombus]] extension.<ref name="pmid15921382">{{cite journal |vauthors=Wichers IM, Di Nisio M, Büller HR, Middeldorp S |title=Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review |journal=Haematologica |volume=90 |issue=5 |pages=672–7 |year=2005 |pmid=15921382 |doi= |url=}}</ref>
*[[Low molecular weight heparin]] is considered the treatment of choice, and proved to be superior to the [[NSAID]] in preventing extension of superficial thrombophlebitis.<ref name="pmid15921382">{{cite journal |vauthors=Wichers IM, Di Nisio M, Büller HR, Middeldorp S |title=Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review |journal=Haematologica |volume=90 |issue=5 |pages=672–7 |year=2005 |pmid=15921382 |doi= |url=}}</ref><ref name="pmid22360152">{{cite journal| author=Rathbun SW, Aston CE, Whitsett TL| title=A randomized trial of dalteparin compared with ibuprofen for the treatment of superficial thrombophlebitis. | journal=J Thromb Haemost | year= 2012 | volume= 10 | issue= 5 | pages= 833-9 | pmid=22360152 | doi=10.1111/j.1538-7836.2012.04669.x | pmc=PMC3343207 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22360152  }} </ref>
*Other [[anticoagulants]] which may be used include [[warfarin]], [[unfractionated heparin]] or [[fondaparinux]].<ref name="pmid15921382">{{cite journal |vauthors=Wichers IM, Di Nisio M, Büller HR, Middeldorp S |title=Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review |journal=Haematologica |volume=90 |issue=5 |pages=672–7 |year=2005 |pmid=15921382 |doi= |url=}}</ref>
 
====[[Topical|Topical Agents]]====
Some topical [[Anti-inflammatory medication|anti-inflammatory agents]] (e.g. [[Diclofenac|diclofenac gel]]) has been found to reduce the [[pain]], and help resolution of the [[inflammation]].
 
====[[Antibiotics]]====
When [[suppurative thrombophlebitis]] is suspected, [[antibiotic]] treatment should be started.
 
===[[Surgery]]===
Conservative measures and medical therapy are considered the first line treatment for patients with thrombophlebitis. However, patients with recurrent thrombophlebitis are candidates for surgical intervention, such as [[venous]] [[stripping]] or [[ligation]].<ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref><ref name="pmid18512540">{{cite journal |vauthors=Blättler W, Schwarzenbach B, Largiadèr J |title=Superficial vein thrombophlebitis--serious concern or much ado about little? |journal=VASA |volume=37 |issue=1 |pages=31–8 |year=2008 |pmid=18512540 |doi=10.1024/0301-1526.37.1.31 |url=}}</ref>
 
==Prevention==
 
===[[Primary Prevention Guidelines Recommendations|Primary Prevention]]===
The following preventive measures can be done to decrease the [[incidence]] of thrombophlebitis:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref><ref name="pmid8624665">{{cite journal |vauthors=Guex JJ |title=Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis |journal=Dermatol Surg |volume=22 |issue=4 |pages=378–82 |year=1996 |pmid=8624665 |doi= |url=}}</ref><ref name="pmid2195069">{{cite journal |vauthors=Samlaska CP, James WD |title=Superficial thrombophlebitis. II. Secondary hypercoagulable states |journal=J. Am. Acad. Dermatol. |volume=23 |issue=1 |pages=1–18 |year=1990 |pmid=2195069 |doi= |url=}}</ref><ref name="pmid25521017">{{cite journal |vauthors=Scott G, Mahdi AJ, Alikhan R |title=Superficial vein thrombosis: a current approach to management |journal=Br. J. Haematol. |volume=168 |issue=5 |pages=639–45 |year=2015 |pmid=25521017 |doi=10.1111/bjh.13255 |url=}}</ref>
*Encourage early mobilization after [[surgery]] to prevent [[venous stasis]]
*Avoid prolonged [[cannulation]] or change [[cannula]] after no more than 48 hours
*Consider [[anticoagulants]] for patients with [[coagulation disorders]] or [[Hypercoagulable state|hypercoagulable states]]
 
===[[Secondary Prevention]]===
Medical therapy with [[anticoagulants]] can decrease the rate of recurrence of thrombophlebitis.
 


== Case Studies ==
==References==
[[Thrombophlebitis case study one|Case #1]]
{{reflist|2}}
{{Circulatory system pathology}}


{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
Line 41: Line 309:
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
[[Category:Vascular medicine]]
[[Category:Cardiology]]

Latest revision as of 00:25, 30 July 2020

WikiDoc Resources for Thrombophlebitis

Articles

Most recent articles on Thrombophlebitis

Most cited articles on Thrombophlebitis

Review articles on Thrombophlebitis

Articles on Thrombophlebitis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Thrombophlebitis

Images of Thrombophlebitis

Photos of Thrombophlebitis

Podcasts & MP3s on Thrombophlebitis

Videos on Thrombophlebitis

Evidence Based Medicine

Cochrane Collaboration on Thrombophlebitis

Bandolier on Thrombophlebitis

TRIP on Thrombophlebitis

Clinical Trials

Ongoing Trials on Thrombophlebitis at Clinical Trials.gov

Trial results on Thrombophlebitis

Clinical Trials on Thrombophlebitis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Thrombophlebitis

NICE Guidance on Thrombophlebitis

NHS PRODIGY Guidance

FDA on Thrombophlebitis

CDC on Thrombophlebitis

Books

Books on Thrombophlebitis

News

Thrombophlebitis in the news

Be alerted to news on Thrombophlebitis

News trends on Thrombophlebitis

Commentary

Blogs on Thrombophlebitis

Definitions

Definitions of Thrombophlebitis

Patient Resources / Community

Patient resources on Thrombophlebitis

Discussion groups on Thrombophlebitis

Patient Handouts on Thrombophlebitis

Directions to Hospitals Treating Thrombophlebitis

Risk calculators and risk factors for Thrombophlebitis

Healthcare Provider Resources

Symptoms of Thrombophlebitis

Causes & Risk Factors for Thrombophlebitis

Diagnostic studies for Thrombophlebitis

Treatment of Thrombophlebitis

Continuing Medical Education (CME)

CME Programs on Thrombophlebitis

International

Thrombophlebitis en Espanol

Thrombophlebitis en Francais

Business

Thrombophlebitis in the Marketplace

Patents on Thrombophlebitis

Experimental / Informatics

List of terms related to Thrombophlebitis

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Synonyms and keywords: White Leg; phlebitis

Overview

Thrombophlebitis is inflammation of a vein, usually associated with the formation of a thrombus within the superficial venous system. It can occur in any superficial venous system, but most commonly in the lower limbs. Symptoms of thrombophlebitis include pain along the course of the vein, redness, itching and swelling around the site of thrombophlebitis. The treatment of thrombophlebitis consists of compression stockings, analgesia, as well as anticoagulants. The most feared complications are DVT and PE.

Historical Perspective

  • In 1913, Burnham AC discussed thrombophlebitis in postoperative patients.[1]
  • Historically, the treatment of thrombophlebitis was purely surgical and consisted of removal of the thrombosed vein.[2]

Classification

Thrombophlebitis can be classified according to the cause into:[3]

Type of Thrombophlebitis Description
Sterile Most common type of thrombophlebitis
Traumatic Associated with the following conditions:
Infective Mostly due to prolonged IV cannulation
Migratory Recurrent thrombophlebitis at various sites. Associated with an underlying malignancy, most commonly adenocarcinoma of the pancreas

Thrombophlebitis may also be classified according to the site into:[4]

  1. Superficial thrombophlebitis of the lower limb: most common location and it involves the great and short saphenous veins.
  2. Superficial thrombophlebitis of the arms
  3. Superficial thrombophlebitis of the breast: also known as Mondor's disease
  4. Superficial thrombophlebitis of the abdominal wall

Pathophysiology

Pathogenesis

The pathogenesis of thrombophlebitis is related to 3 important factors:[3][5][6]

These 3 factors (known as Virchow's triad) predispose to thrombus formation within the veins and subsequently to thrombophlebitis.

Associated Conditions

Thrombophlebitis may be associated with the following conditions:

Causes

Common Causes

Differentiating Thrombophlebitis from other Diseases

Thrombophlebitis must be differentiated from the following conditions causing pain, swelling and palpapable mass in the extremities:[11][12][13][14]

Condition Predilection Site Pain Redness Warmth Swelling of Surrounding Tissue Itching Palpable Mass Systemic Symptoms
Varicose veins Lower limb + - - + + - -
Deep vein thrombosis Lower limb + + + + - - Systemic symptoms are present if DVT is complicated by PE. These include:
Cellulitis No sites of predilection + + + + - -
Lymphangitis Commonly the extremities + + - + - - May be accompanied by:
Lymphedema Lower limb - - - + - -
Baker's cyst Lower limb +/- - - + - Sensation of a water-filled balloon on the posterior aspect of the knee and calf -
Polyarteritis nodosa Cutaneous PAN most commonly involves

the lower limb

+ - - - - Nodules
Ruptured medial head of gastrocnemius Lower limb + - - + - Painful lump at the site of rupture -

Epidemiology and Demographics

Epidemiology

Incidence

  • The incidence of thrombophlebitis is estimated at 100 per 100,000 cases.[4][15]
  • Thrombophlebitis is 6 times more common than DVT.[4]

Demographics

Age

  • Thrombophlebitis is more common in elderly.[4]

Risk Factors

The following are associated with an increased risk of thrombophlebitis:[3][5][6][4]

Natural History, Complications and Prognosis

Natural History

Thrombophlebitis was thought of as a benign condition. However, if left untreated, thrombophlebitis can recur or extend to involve the deep venous system. DVT can still complicate 10% of cases, despite treatment.[19]

Complications

Complications of thrombophlebitis include:[3][20][21][22][23]

Prognosis

The prognosis of thrombophlebitis is generally good with medical treatment. However, despite treatment, DVT can complicate about 10% of cases of thrombophlebitis.

Screening

There are no screening recommendations for thrombophlebitis.[30]

Diagnosis

History and Symptoms

The following symptoms are often (but not always) present in patients with thrombophlebitis:[31][4][15]

Physical Examination

Examination of the skin and affected area reveals the following:[4][15][31]

Laboratory Findings

D-Dimer

D-Dimer is not a useful laboratory test in the diagnosis of isolated cases of superficial thrombophlebitis. However, it may be useful in the case of a concomitant DVT.[4]

Ultrasound

Venous Duplex Ultrasound

Although the diagnosis of thrombophlebitis is mostly clinical, venous Duplex ultrasound is considered the imaging of choice in suspected cases.[4][23] Venous Duplex ultrasound can identify the following:

Other Imaging Findings

There are no other imaging findings associated with thrombophlebitis.

Other Diagnostic Studies

There are no other diagnostic studies associated with thrombophlebitis.

Treatment

Medical Therapy

The following interventions are used as a mainstay in treatment of thrombophlebitis:[3][19][38][23]

Nonsteroidal Anti-Inflammatory Drugs

All NSAIDs have the same effect in the treatment of thrombophlebitis.[39] They are effective in reducing the pain, and decrease the extension of thrombosis.[40][15]

Anticoagulation

Topical Agents

Some topical anti-inflammatory agents (e.g. diclofenac gel) has been found to reduce the pain, and help resolution of the inflammation.

Antibiotics

When suppurative thrombophlebitis is suspected, antibiotic treatment should be started.

Surgery

Conservative measures and medical therapy are considered the first line treatment for patients with thrombophlebitis. However, patients with recurrent thrombophlebitis are candidates for surgical intervention, such as venous stripping or ligation.[4][38]

Prevention

Primary Prevention

The following preventive measures can be done to decrease the incidence of thrombophlebitis:[3][5][6][4]

Secondary Prevention

Medical therapy with anticoagulants can decrease the rate of recurrence of thrombophlebitis.


References

  1. ↑ Burnham AC (1913). "II. Postoperative Thrombophlebitis". Ann. Surg. 57 (2): 151–62. PMC 1407408. PMID 17862964.
  2. ↑ Homans J (1928). "THROMBOPHLEBITIS OF THE LOWER EXTREMITIES". Ann. Surg. 87 (5): 641–51. PMC 1398549. PMID 17865873.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Nasr H, Scriven JM (2015). "Superficial thrombophlebitis (superficial venous thrombosis)". BMJ. 350: h2039. PMID 26099257.
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 Scott G, Mahdi AJ, Alikhan R (2015). "Superficial vein thrombosis: a current approach to management". Br. J. Haematol. 168 (5): 639–45. doi:10.1111/bjh.13255. PMID 25521017.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Guex JJ (1996). "Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis". Dermatol Surg. 22 (4): 378–82. PMID 8624665.
  6. ↑ 6.0 6.1 6.2 Samlaska CP, James WD (1990). "Superficial thrombophlebitis. II. Secondary hypercoagulable states". J. Am. Acad. Dermatol. 23 (1): 1–18. PMID 2195069.
  7. ↑ Martinelli I, Cattaneo M, Taioli E, De Stefano V, Chiusolo P, Mannucci PM (1999). "Genetic risk factors for superficial vein thrombosis". Thromb. Haemost. 82 (4): 1215–7. PMID 10544900.
  8. ↑ Olin JW (2000). "Thromboangiitis obliterans (Buerger's disease)". N. Engl. J. Med. 343 (12): 864–9. doi:10.1056/NEJM200009213431207. PMID 10995867.
  9. ↑ Diaconu C, Mateescu D, Bălăceanu A, Marcu M, Jianu V, Stănică A (2010). "Pancreatic cancer presenting with paraneoplastic thrombophlebitis--case report". J Med Life. 3 (1): 96–9. PMC 3019029. PMID 20302205.
  10. ↑ Varki A (2007). "Trousseau's syndrome: multiple definitions and multiple mechanisms". Blood. 110 (6): 1723–9. doi:10.1182/blood-2006-10-053736. PMC 1976377. PMID 17496204.
  11. ↑ Cohen AT, Dobromirski M, Gurwith MM (2014). "Managing pulmonary embolism from presentation to extended treatment". Thromb Res. 133 (2): 139–48. doi:10.1016/j.thromres.2013.09.040. PMID 24182642.
  12. ↑ Füeßl HS (2016). "[Emergency checklist: Acute lymphangitis]". MMW Fortschr Med (in German). 158 (11): 65. doi:10.1007/s15006-016-8384-9. PMID 27271418.
  13. ↑ Chung E, Pulitzer MP, Papadopoulos EB, Papanicolaou GA, Babady NE, Marchetti MA (2015). "Lymphangitic papules caused by Nocardia takedensis". JAAD Case Rep. 1 (3): 126–8. doi:10.1016/j.jdcr.2015.03.001. PMC 4808715. PMID 27051706.
  14. ↑ lymphangitis Mandell, GERALD L. "Mandell, Douglas, and Bennett's." Principles and practice of infectious diseases 7 (1995) Accessed on October 12,2016
  15. ↑ 15.0 15.1 15.2 15.3 Di Nisio M, Wichers IM, Middeldorp S (2013). "Treatment for superficial thrombophlebitis of the leg". Cochrane Database Syst Rev (4): CD004982. doi:10.1002/14651858.CD004982.pub5. PMID 23633322.
  16. ↑ 16.0 16.1 Gillet JL, Allaert FA, Perrin M (2004). "[Superficial thrombophlebitis in non varicose veins of the lower limbs. A prospective analysis in 42 patients]". J Mal Vasc (in French). 29 (5): 263–72. PMID 15738838.
  17. ↑ De Maeseneer MG (2005). "Superficial thrombophlebitis of the lower limb: practical recommendations for diagnosis and treatment". Acta Chir. Belg. 105 (2): 145–7. PMID 15906904.
  18. ↑ McColl MD, Ramsay JE, Tait RC, Walker ID, McCall F, Conkie JA, Carty MJ, Greer IA (1997). "Risk factors for pregnancy associated venous thromboembolism". Thromb. Haemost. 78 (4): 1183–8. PMID 9364982.
  19. ↑ 19.0 19.1 Di Nisio M, Middeldorp S (2014). "Treatment of lower extremity superficial thrombophlebitis". JAMA. 311 (7): 729–30. doi:10.1001/jama.2014.520. PMID 24549553.
  20. ↑ 20.0 20.1 20.2 Lutter KS, Kerr TM, Roedersheimer LR, Lohr JM, Sampson MG, Cranley JJ (1991). "Superficial thrombophlebitis diagnosed by duplex scanning". Surgery. 110 (1): 42–6. PMID 1866693.
  21. ↑ 21.0 21.1 Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ (1996). "Progression of superficial venous thrombosis to deep vein thrombosis". J. Vasc. Surg. 24 (5): 745–9. PMID 8918318.
  22. ↑ 22.0 22.1 Bergqvist D, Jaroszewski H (1986). "Deep vein thrombosis in patients with superficial thrombophlebitis of the leg". Br Med J (Clin Res Ed). 292 (6521): 658–9. PMC 1339644. PMID 3081214.
  23. ↑ 23.0 23.1 23.2 Sándor T (2017). "[Superficial venous thrombosis. A state of art]". Orv Hetil (in Hungarian). 158 (4): 129–138. doi:10.1556/650.2017.30618. PMID 28116936.
  24. ↑ 24.0 24.1 Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J (1998). "Occult deep venous thrombosis complicating superficial thrombophlebitis". J. Vasc. Surg. 27 (2): 338–43. PMID 9510288.
  25. ↑ 25.0 25.1 Hanson JN, Ascher E, DePippo P, Lorensen E, Scheinman M, Yorkovich W, Hingorani A (1998). "Saphenous vein thrombophlebitis (SVT): a deceptively benign disease". J. Vasc. Surg. 27 (4): 677–80. PMID 9576081.
  26. ↑ 26.0 26.1 Verlato F, Zucchetta P, Prandoni P, Camporese G, Marzola MC, Salmistraro G, Bui F, Martini R, Rosso F, Andreozzi GM (1999). "An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh". J. Vasc. Surg. 30 (6): 1113–5. PMID 10587397.
  27. ↑ Decousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G, Leizorovicz A (2010). "Fondaparinux for the treatment of superficial-vein thrombosis in the legs". N. Engl. J. Med. 363 (13): 1222–32. doi:10.1056/NEJMoa0912072. PMID 20860504.
  28. ↑ Belcaro G (1990). "Evolution of superficial vein thrombosis treated with defibrotide: comparison with low dose subcutaneous heparin". Int J Tissue React. 12 (5): 319–24. PMID 2098372.
  29. ↑ Belcaro G, Nicolaides AN, Errichi BM, Cesarone MR, De Sanctis MT, Incandela L, Venniker R (1999). "Superficial thrombophlebitis of the legs: a randomized, controlled, follow-up study". Angiology. 50 (7): 523–9. PMID 10431991.
  30. ↑ U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=thrombophlebitis. Accessed on Feb. 15, 2017
  31. ↑ 31.0 31.1 Gizurarson JG, Filippusson H (2015). "Conjugation of D-glucosamine to bovine trypsin increases thermal stability and alters functional properties". Enzyme Microb. Technol. 75-76: 1–9. doi:10.1016/j.enzmictec.2015.04.005. PMID 26047909.
  32. ↑ Binder B, Lackner HK, Salmhofer W, Kroemer S, Custovic J, Hofmann-Wellenhof R (2009). "Association between superficial vein thrombosis and deep vein thrombosis of the lower extremities". Arch Dermatol. 145 (7): 753–7. doi:10.1001/archdermatol.2009.123. PMID 19620555.
  33. ↑ Bounameaux H, Reber-Wasem MA (1997). "Superficial thrombophlebitis and deep vein thrombosis. A controversial association". Arch. Intern. Med. 157 (16): 1822–4. PMID 9290540.
  34. ↑ Messmore HL, Bishop M, Wehrmacher WH (1991). "Acute venous thrombosis. Therapeutic choices for superficial and deep veins". Postgrad Med. 89 (7): 73–7. PMID 2031032.
  35. ↑ Skillman JJ, Kent KC, Porter DH, Kim D (1990). "Simultaneous occurrence of superficial and deep thrombophlebitis in the lower extremity". J. Vasc. Surg. 11 (6): 818–23, discussion 823–4. PMID 2193177.
  36. ↑ Quéré I, Leizorovicz A, Galanaud JP, Presles E, Barrellier MT, Becker F, Desprairies G, Guenneguez H, Mismetti P, Décousus H (2012). "Superficial venous thrombosis and compression ultrasound imaging". J. Vasc. Surg. 56 (4): 1032–8.e1. doi:10.1016/j.jvs.2012.03.014. PMID 22832262.
  37. ↑ Ellis MH, Fajer S (2013). "A current approach to superficial vein thrombosis". Eur. J. Haematol. 90 (2): 85–8. doi:10.1111/ejh.12044. PMID 23181477.
  38. ↑ 38.0 38.1 Blättler W, Schwarzenbach B, Largiadèr J (2008). "Superficial vein thrombophlebitis--serious concern or much ado about little?". VASA. 37 (1): 31–8. doi:10.1024/0301-1526.37.1.31. PMID 18512540.
  39. ↑ Di Nisio, M.; Wichers, IM.; Middeldorp, S. (2013). "Treatment for superficial thrombophlebitis of the leg". Cochrane Database Syst Rev. 4: CD004982. doi:10.1002/14651858.CD004982.pub5. PMID 23633322.
  40. ↑ "A pilot randomized double-blind comparison of a low-molecular-weight heparin, a nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial vein thrombosis". Arch Intern Med. 163 (14): 1657–63. 2003. doi:10.1001/archinte.163.14.1657. PMID 12885680. Unknown parameter |month= ignored (help)
  41. ↑ 41.0 41.1 41.2 Wichers IM, Di Nisio M, Büller HR, Middeldorp S (2005). "Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review". Haematologica. 90 (5): 672–7. PMID 15921382.
  42. ↑ Rathbun SW, Aston CE, Whitsett TL (2012). "A randomized trial of dalteparin compared with ibuprofen for the treatment of superficial thrombophlebitis". J Thromb Haemost. 10 (5): 833–9. doi:10.1111/j.1538-7836.2012.04669.x. PMC 3343207. PMID 22360152.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Thrombophlebitis&oldid=1643886"