Superficial thrombophlebitis (superficial phlebitis) is inflammation and clotting in a superficial vein. Superficial thrombophlebitis means that a blood clot has formed in a vein close to the skin. There may also be an infection in the vein. You may get a thrombophlebitis in a leg vein or an arm vein. With care, this problem should clear up within 2 to 3 weeks. Superficial thrombophlebitis most often affects the superficial veins in the legs but may also affect superficial veins in the
groin. Often, thrombophlebitis occurs in people with varicose veins; however, most people with varicose veins do not develop thrombophlebitis.
Even a slight injury can cause a varicose vein to become inflamed. Unlike deep vein thrombosis, which causes very little inflammation, superficial thrombophlebitis involves a sudden (acute) inflammatory reaction that causes the thrombus to adhere firmly to the vein wall and lessens the likelihood that it will break loose. Unlike deep veins, superficial veins have no surrounding muscles to squeeze and dislodge a thrombus. For these reasons, superficial thrombophlebitis rarely causes embolism. Thrombophlebitis that repeatedly occurs in normal veins is called migratory phlebitis or migratory thrombophlebitis. It may indicate a serious underlying disorder, such as cancer of an internal organ. When migratory phlebitis and cancer of an internal organ occur together, the disorder is called Trousseau's syndrome.
Thrombophlebitis may be caused by an infection or an injury to a vein. Other causes may be not moving soon enough after surgery or resting in bed for a long time. You may get a thrombophlebitis from wearing a cast which can cause your blood to pool. Smoking and taking birth control pills may also cause blood clots. Taking street drugs as shots in your veins may injure the wall of your vein and cause a thrombophlebitis. Other causes may be varicose veins, pregnancy, or irritation from an IV in your vein. Superficial thrombophlebitis may occur after recently using a intravenous (IV) line, or after trauma to the vein. It involves an inflammatory response associated with a clot in the vein. Risks include an increased blood clotting tendency, infection, current or recent pregnancy, varicose veins, and chemical or other irritation of the area. Prolonged sitting, standing, or immobilization increase the risk. Superficial thrombophlebitis may occasionally be associated with abdominal cancers (such as carcinoma of the pancreas), deep vein thrombosis, thromboangiitis obliterans, and (rarely) with pulmonary embolus.
Localized pain and swelling develop rapidly, the skin over the vein becomes red, and the area feels warm and is very tender. Because blood in the vein is clotted, the vein feels like a hard cord under the skin, not soft like a normal or varicose vein. The vein may feel hard along its entire length. The diagnosis is usually obvious to doctors just from examining the painful area. However, doctors must distinguish superficial thrombophlebitis from cellulitis, which is treated differently.
Most often, superficial thrombophlebitis subsides by itself. Taking an analgesic, such as aspirin or another nonsteroidal anti-inflammatory drug (NSAIDs), usually helps relieve the pain. Although the inflammation generally subsides in a matter of days, several weeks may pass before the lumps and tenderness subside completely. To provide early relief, doctors may inject a local anesthetic, remove the thrombus, and then apply a compression bandage, which the person wears for several days.
When superficial thrombophlebitis occurs in the groin, where the main superficial vein joins the main deep vein, a thrombus may extend into the deep vein. Such a thrombus may break loose to become an embolus. To prevent this extension, some surgeons recommend emergency surgery to tie off the superficial vein. Usually, this surgery can be performed using a local anesthetic and without admitting the person to the hospital. Normal activities may be resumed afterward.
If an intravenous line is in use, the risk of superficial thrombophlebitis may be reduced by routine rotation of the IV site and immediate removal of the IV line if signs of inflammation develop.