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Thrombophlebitis

Thrombophlebitis is inflammation of a vein (usually in an extremity, especially one of the legs) that occurs in response to a blood clot in the vessel. When it occurs in a vein near the surface of the skin, it is known as superficial thrombophlebitis, a minor disorder commonly identified by a red, tender vein.

Deep-vein thrombophlebitis (affecting the larger veins farther below the skin’s surface) is more serious. It may produce less-pronounced symptoms at first (half of all cases are asymptomatic) but carries the risks of pulmonary embolism (when the clot detaches from its place of origin and travels to the lung) and chronic venous insufficiency (impaired outflow of blood through the veins), resulting in dermatitis, increased skin pigmentation and swelling.

Thrombophlebitis is common, with high rates of incidence among women and older people.

When to Call Your Doctor
Symptoms
Causes
Prevention
Diagnosis
Treatment

When to Call Your Doctor
Call your doctor if you have a painful, swollen vein that does not disappear in a few days, or if you have unexplained swelling in an arm or leg.

Symptoms

  • Superficial thrombophlebitis: a red, engorged, cordlike vein, associated with localized swelling, pain or tenderness.
  • Deep-vein thrombophlebitis: generalized swelling, warmth and redness in the affected limb; distention of superficial veins; bluish skin color in the limb or toes (cyanosis); and rarely, fever and chills.

Causes

  • Stagnation of blood flow due to immobility. This is common among bedridden patients (such as heart patients and those who have undergone any type of major or orthopedic surgery, especially of the hip or knee) and healthy persons who sit or lie still for an extended period --for example, on a long trip.
  • Blood vessel injury, caused by trauma, intravenous catheters or needles, chemotherapeutic agents, or infectious organisms.
  • Conditions that increase the tendency for blood to coagulate, such as a familial deficiency in anti-clotting factors or disorders like systemic lupus erythematosus.
  • Pregnancy and varicose veins are associated with a higher risk of superficial thrombophlebitis.
  • Deep-vein thrombophlebitis is associated with a number of different cancers.

Prevention
Be sure to stand up and walk around often on long trips. Following a heart attack or major surgery, low doses of an anticoagulant (such as heparin or warfarin) may be recommended. Getting up and walking around again as soon as possible following either of those events is also advised.

Diagnosis
Thrombophlebitis occurs when a blood clot and inflammation develop in one or more of your veins, typically in your legs. On rare occasions, thrombophlebitis can affect veins in your arms. The condition is one of several managed by doctors with Johns Hopkins’ Division of Vascular Surgery, directed by Dr. Bruce Perler.

We apply a multidisciplinary team approach to providing expedient and expert care in the management of simple as well as complex vascular disorders. The members within the division devote their full energies toward a better understanding of vascular disease and raising the standards of vascular surgical practice.

The affected vein in thrombophlebitis may be near the surface of your skin (called superficial thrombophlebitis) or deep within a muscle (called deep-vein thrombophlebitis). The cause often is prolonged inactivity, such as sitting during a long period of travel in an airplane or automobile or lengthy bed rest after surgery.

Doctors can usually diagnose superficial thrombophlebitis based on your medical history and a physical examination. Deep-vein thrombophlebitis is harder to diagnose, so the doctor may require further tests.

The doctor will usually perform a venous duplex examination, a type of imaging test, to see how efficiently the veins are returning blood to your heart. This test also detects blood clots in the legs. While you lie on your back, a small ultrasound imaging device is placed on the skin over the major veins in the leg, allowing the technician to both see the veins and listen to the flow of blood. Pictures may be taken at various sites.

Treatment
The physicians within the Johns Hopkins’ Division of Vascular Surgery treat thrombophlebitis in various ways, including the following treatment options:

  • If superficial thrombophlebitis is the diagnosis, your doctor will recommend you be up and active. You also should be checked frequently to make sure that the blood clot does not progress.
  • Patients with deep-vein thrombophlebitis may require hospitalization, though some patients can be seen on an outpatient basis. Bed rest and elevation of the affected limb are essential. The doctor will usually prescribe an anti-clotting medication, usually heparin, to be given intravenously for seven to ten days. Outpatients are given anti-clotting pills.
  • Clot-dissolving agents, such as urokinase or tissue plasminogen activator, may be administered to resolve the condition.
  • Special elastic support stockings may be prescribed to aid circulation in the lower limbs.
  • The doctor may implant a small filter in the main vein of your abdomen to prevent clots in the legs from going to the lung.

 

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