Thrombophlebitis

Thrombophlebitis
Radiological image showing Thrombosis of the Great Saphenous Vein.
Classification and external resources
Specialty	cardiology
ICD-10	I80, I82.1
ICD-9-CM	451
MedlinePlus	001108
MeSH	D013924

Thrombophlebitis is phlebitis (vein inflammation) related to a thrombus (blood clot).^[1] When it occurs repeatedly in different locations, it is known as "Thrombophlebitis migrans", "migrating thrombophlebitis" or Trousseau's syndrome.

Signs and symptoms

The following symptoms are often (but not always) associated with thrombophlebitis:^[2]

pain in the part of the body affected
skin redness or inflammation (not always present)
swelling (edema) of the extremities (ankle and foot)
palpable cord-like veins
localized warmth and tenderness of the leg

Although, note that thrombophlebitis is not restricted to the veins of the lower limbs (leg), but can also occur in arm veins.

Causes

Thrombophlebitis (another medical term is "White Leg") is related to a thrombus in a superficial vein. Risk factors include disorders related to increased tendency for blood clotting, injury to vein wall, and reduced speed of blood in the veins such as varices and prolonged immobility. Prolonged traveling by car or airplane may promote a blood clot leading to thrombophlebitis but this occurs relatively rarely. Specific disorders associated with thrombophlebitis include superficial thrombophlebitis (affects veins near the skin surface), deep venous thrombosis (affects deeper, larger veins), and pulmonary embolism. High estrogen states such as pregnancy, estrogen replacement therapy, or oral contraceptives are associated with an increased risk of thrombophlebitis. Those with familial clotting disorders such as Protein S deficiency, Protein C deficiency, or Factor V Leiden are also at increased risk of thrombophlebitis. Thrombophlebitis can be found in people with vasculitis including Behçet's disease. Thrombophlebitis migrans can be a sign of malignancies such as pancreatic carcinoma (Trousseau sign of malignancy).^[3]

Diagnosis

The health care provider makes the diagnosis primarily based on the appearance of the affected area. Frequent checks of the pulse, blood pressure, temperature, skin condition, and circulation may be required.

If the cause is not readily identifiable, tests may be performed to determine the cause, including the following:

Doppler ultrasound
Extremity arteriography
Blood coagulation studies (Blood clotting tests)

Prevention

Routine changing of intravenous (IV) lines helps to prevent phlebitis related to IV lines. See the specific disorders associated with thrombophlebitis for other preventive measures.

Treatment

For more specific recommendations, see the particular condition. In general, treatment may include the following:

Medications
- analgesics (pain medications)
- anticoagulants e.g. warfarin or heparin to prevent new clot formation
- thrombolytics to dissolve an existing clot such as intravenous streptokinase.
- nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen to reduce pain and inflammation
- Support stockings and wraps to reduce discomfort

The patient may be advised to do the following:

Elevate the affected area to reduce swelling.
Keep pressure off of the area to reduce pain and decrease the risk of further damage.
Surgical removal, stripping, or bypass of the vein is rarely needed but may be recommended in some situations.

Prognosis

Thrombophlebitis and other forms of phlebitis usually respond to prompt medical treatment.

Complications

Not all superficial thrombophlebitis is benign ^[4] Complications are rare, but when they occur they can be serious. The most serious complication occurs when the superficial blood clot is associated with a deeper venous thrombosis; this can then dislodge, traveling through the heart and occluding the dense capillary network of the lungs; this is a pulmonary embolism which can be potentially life-threatening.

References

↑ Torpy JM, Burke AE, Glass RM (July 2006). "JAMA patient page. Thrombophlebitis". JAMA 296 (4): 468. doi:10.1001/jama.296.4.468. PMID 16868304.
↑ Thrombophlebitis. MedlinePlus Medical Encyclopedia. Public domain text. Update Date: 4/19/2004. Updated by: Brian F. Burke M.D., Department of Internal Medicine, Munson Medical Center, Traverse City, MI. Review provided by VeriMed Healthcare Network.
↑ "Superficial Thrombophlebitis". 2014-04-21. Retrieved 2015-01-23.
↑ Venous Review The Official Journal of Center for Vein Restoration

Arteriosclerosis	Atherosclerosis Foam cell Fatty streak Atheroma Intermittent claudication Critical limb ischemia Monckeberg's arteriosclerosis Arteriolosclerosis Hyaline Hyperplastic Cholesterol LDL Oxycholesterol Trans fat

Stenosis	Carotid artery stenosis Renal artery stenosis

Other	Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon

Aneurysm / dissection /
pseudoaneurysm

Vascular malformation

Vascular nevus

Veins

Inflammation	Phlebitis

Venous thrombosis / Thrombophlebitis	primarily lower limb Deep vein thrombosis abdomen Hepatic veno-occlusive disease Budd–Chiari syndrome May–Thurner syndrome Portal vein thrombosis Renal vein thrombosis upper limb / torso Mondor's disease Paget–Schroetter disease head Cerebral venous sinus thrombosis Post-thrombotic syndrome

Varicose veins	Gastric varices Portacaval anastomosis Caput medusae Esophageal varices Hemorrhoid Varicocele

Other	Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer

Arteries or veins

Blood pressure

Hypertension	Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension

Hypotension	Orthostatic hypotension

Authority control	NDL: 01195329

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