Phlebitis of the Superficial Veins

Superficial Thrombophlebitis

I have many patients come to my office for the first time with phlebitis of the superficial veins.  This is a condition that is rarely life threatening and fairly common in patients with varicose veins.  My concern is that many patients referred to my office have already been seen and diagnosed by their physician, and in my opinion, have not been properly diagnosed.  A complete diagnostic work up is very important because many cases of simple superficial phlebitis are associated with deep vein thrombosis which I have already discussed.  Deep vein thrombosis is associated to very serious complications and can even lead to death.

Importance of a complete diagnostic work up.

Phlebitis of the superficial veins can occur spontaneously or from trauma, sometimes after surgical and/or medical procedures.  Clinical examination alone can not rule out a deep vein thrombosis that may co-exist.  When they co-exist, it is common to see no signs of the deep vein thrombosis, so the deep vein thrombosis remains silent. Studies have shown that up to 30% of people with the harmless superficial variety have occult deep vein thrombosis and if patients are not followed up properly with an ultrasound treatment, it has been found that 45% will develop DVT.  In patients that are hospitalized and develop Superficial Phlebitis, 10% will develop a pulmonary embolus and 20% of these patients will die. The reason for this is that the mechanisms that cause superficial phlebitis are the same that cause a clot in the deep system.  The pathogenesis is the same and the risk factors are the same.

Signs and symptoms of superficial phlebitis.

Patients experience localized tenderness over the involved vein.  Usually, the vein is tender and can have a hard feeling to it.  The skin over the involved vein may become red.  Most patients can be treated with anti-inflammatory medicine like Advil or Aleve.  The important thing is to make sure your doctor rules out a more serious DVT.  Patients need a Duplex ultrasound.  It is also important to obtain a duplex ultrasound of the unaffected leg also, because if the phlebitis was from a clotting problem or hypercoagulable state it could affect the other leg in the same way.  Patients should also have lab work drawn to rule out a hypercoagulable state.  This is called a thrombotic risk profile which checks to see if there is something in your blood to make you more prone to blood clots. Once a DVT has been ruled out, the patient with superficial phlebitis should be followed closely with repeat ultrasounds until the phlebitis has resolved.  Sometimes the superficial vein can extend into the deep system so repeat ultrasounds are mandatory.

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