Superficial thrombophlebitis

Animation - how superficial thrombophlebitis develops

          

About superficial thrombophlebitis

The circulatory system

The circulatory system controls the flow of blood around your body. Blood is pumped from your heart around your body through arteries. Once it has supplied oxygen and nutrients, blood returns to your heart through your veins. To do this, the blood in your veins must flow upwards, against gravity. The muscles in your legs help this upward blood flow. Each time your calf and thigh muscles contract when you're walking, veins deep inside your leg are squeezed. One-way valves help prevent blood from flowing back down your veins.

There are two main types of veins: superficial veins, just below the surface of your skin, and deep veins, found deep inside the body that carry the most blood. These two types of veins are connected by perforator veins. When blood doesn't flow properly from your superficial veins to your deep veins, pressure can build up in your superficial veins. This results in blood collecting (pooling) in your veins – these are called varicose veins. 

What is superficial thrombophlebitis?

Superficial thrombophlebitis occurs when a superficial vein becomes inflamed and a blood clot forms within the vein. It usually occurs in varicose veins, commonly in the leg, but it can happen as a result of an injury to any vein, for example from having an injection into a vein in your arm.

Symptoms of superficial thrombophlebitis

If you have superficial thrombophlebitis you may have symptoms including:

  • a swollen calf or thigh
  • pain or tenderness
  • your vein feeling hard when you touch it
  • an enlarged vein
  • your skin feeling hot in the area (this is caused by inflammation)
  • a change in the colour of your skin, to red or purple, for example

The vein may be raised and lumpy for weeks. Sometimes your skin over the affected vein may change colour or a nodule may form in the area, which doesn't go away.

Complications of superficial thrombophlebitis

Generally superficial thrombophlebitis doesn't have any complications. Rarely, it can cause septic thrombophlebitis in the affected vein. Occasionally, this infection can develop to affect the rest of the body and become life-threatening. If the vein becomes infected, your symptoms may get worse and any pain, tenderness, swelling and redness may spread along the entire length of the infected vein. You may also get a fever – a temperature higher than 37.5°C.

Sometimes the blood clot can extend further up the vein. If the clot extends to where the superficial vein and the deep, larger veins join, a deep vein thrombosis (DVT) can develop. If this happens your symptoms may get worse and:

  • the inner part of your thigh, towards your groin, may become inflamed
  • your whole leg (or affected area) may swell
  • you may get chest pains or develop breathing problems

If you have any of these symptoms, seek urgent medical attention.

Causes of superficial thrombophlebitis

Sometimes superficial thrombophlebitis can occur for no known reason. However, there are a number of factors that make you more likely to get superficial thrombophlebitis, such as:

  • varicose veins, as they are more likely to get injured
  • having previously had superficial thrombophlebitis, deep vein thrombosis, or a pulmonary embolism
  • having a central venous catheter or intravenous cannula (used to inject medicines) as these procedures can injure the vein and may trigger inflammation
  • pregnancy or recently giving birth, particularly just after you give birth
  • a slow flow of blood in the superficial veins, for example after surgery, or because of injury or inactivity, such as when travelling long-distance
  • getting older
  • some medicines, such as the contraceptive pill and hormone replacement treatments
  • having cancer
  • obesity
  • inherited conditions that increase the chances of your blood clotting

Diagnosis of superficial thrombophlebitis

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your doctor will usually be able to diagnose superficial thrombophlebitis just from examining you and asking about your symptoms. However, you may need to have tests to rule out DVT, which may include a D-dimer blood test. This measures a substance that develops when a blood clot breaks down. If this is negative, it's unlikely that you have a DVT.

Treatment of superficial thrombophlebitis

Superficial thrombophlebitis usually goes away on its own. You may have symptoms, especially tenderness, for weeks or several months. However, there are a number of treatments that can ease your symptoms.

Self-help

Self-help treatments include:

  • if you have superficial thrombophlebitis in your leg, lift your leg above the height of your heart when resting as this can help increase the flow of blood through your leg and reduce any swelling
  • placing a warm compress ,such as a warm flannel, over the vein as this may ease any pain
  • keeping active as this will help the blood to flow around your body

Medicines

Painkillers may help to ease any pain you have. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are most often used to treat pain from superficial thrombophlebitis. As well as in tablet form, NSAIDs are available as creams or gels, such as ibuprofen gel. These are only suitable if your superficial thrombophlebitis is mild and only affects a small area of the vein. Paracetamol is an alternative if you can't take NSAIDs. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your doctor thinks you have septic superficial thrombophlebitis from a bacterial infection, you may be given antibiotics such as flucloxacillin, erythromycin or clarithromycin. You will usually be given these medicines at your GP surgery, but you may need to go to hospital to have them intravenously (directly into a vein). Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatments

Your GP may prescribe compression stockings for superficial thrombophlebitis to relieve any swelling and provide comfort.

Surgery

If you have varicose veins and you continue to have superficial thrombophlebitis symptoms or you have a large number of varicose veins, surgery may be an option to remove them. Ask your doctor for advice.

Prevention of superficial thrombophlebitis

Try putting your legs above the height of your heart, do gentle exercise such as walking and try not to stand still for periods of time. Move your legs, particularly during long periods of sitting or resting. Your GP may prescribe compression (strong support) stockings for you to wear to prevent thrombophlebitis. Ask your GP for advice.

Speak to your GP before starting hormone treatments to prevent thrombophlebitis.

I keep having thrombophlebitis in a varicose vein in my leg. What should I do?

Answer

You could consider having your varicose vein removed.

Explanation

Superficial thrombophlebitis is more likely to occur or come back if you have varicose veins. If the veins are removed, you’re less likely to have superficial thrombophlebitis again.

There are a variety of treatments for varicose veins such as ligation and stripping surgery, foam or liquid sclerotherapy and laser ablation treatment. However, removal won't prevent superficial thrombophlebitis occurring in other leg veins.

I have a pain in my leg - could it be superficial thrombophlebitis?

Answer

There is a range of different causes of leg pain but it could be superficial thrombophlebitis.

Explanation

Leg pain can have many different causes. Superficial thrombophlebitis can sometimes be confused with other conditions, such as: 

  • skin infections (for example, cellulitis)
  • inflammation in the layer of fat just under the skin (erythema nodosum)
  • deep vein thrombosis (DVT)
  • an injury to muscle or tendons
  • inflammation of a nerve (neuritis)
  • calf strain

You should go to your GP if you have leg pain and are concerned about it.

How can I tell the difference between superficial thrombophlebitis and deep vein thrombosis (DVT)?

Answer

Symptoms of DVT can sometimes appear similar to superficial thrombophlebitis. However, as DVT can be a serious condition, it’s important to see to your GP to get the right diagnosis.

Explanation

Superficial thrombosis will often get better on its own and isn't usually life-threatening. Deep vein thrombosis needs to be treated as it can be fatal. DVT can occur quickly and you may have swelling, pain or warmth in your calf. Yet often people don't have any symptoms. Contact your GP if you’re concerned.

If you have superficial thrombophlebitis, you may have symptoms including:

  • a swollen calf or thigh
  • pain or tenderness
  • your vein feeling hard when you touch it
  • an enlarged vein
  • your skin feeling hot in the area (this is caused by inflammation)
  • a change in the colour of your skin, to red or purple, for example

Sometimes the blood clot can extend further up the vein. If the clot extends to where the superficial vein and the deep, larger veins join, a deep vein thrombosis (DVT) can develop. If this happens, your symptoms may get worse and:

  • the inner part of your thigh, towards your groin, may become inflamed
  • your whole leg (or affected area) may swell
  • you may get chest pains or develop breathing problems

If you have any of these symptoms, seek urgent medical attention.