Introduction

Thrombophlebitis(throm-boe-flush-BY-tis) is a medical condition where a blood clot found in a vein can cause inflammation and pain. Usually, this occurs in the superficial veins near the skin, but in rare cases, these clots can occur in deeper veins within muscles, resulting in deep vein thrombosis(DVT)¹.

 Superficial thrombophlebitis is an inflammatory condition which mainly affects veins in the lower limbs, such as the great saphenous vein in the leg.² Deep thrombophlebitis(also known as deep vein thrombosis) has the same inflammatory process as its counterpart, superficial thrombophlebitis; however, DVTs form in deeper veins, leading to more severe symptoms and a worse prognosis. 

It is important to understand the difference between these two conditions as their diagnoses, treatments, and prognoses differ greatly. 

Causes and risk factors

Like many other blood-related conditions, there are plenty of causes that have been identified as contributors to these two diseases. These include:³

• Prolonged immobilisation(bed rest, airplane travel)
• Pregnancy 
• Obesity
• Fractures in the bones of the pelvis or legs
• Recent surgery 

Although these conditions affect different veins, they have shared risk factors, which include:

• Smoking
• Family history of blood clots 
• Oral contraceptives 
• Varicose veins 
• Previous stroke

Clinical presentation

The major difference in these two conditions is how they present. As mentioned before, ST primarily affects superficial veins and, as such, presents with less severe symptoms. The life-threatening symptoms displayed by patients suffering from DVT are mostly because deeper and more crucial veins are affected in this condition. 

Superficial thrombophlebitis presents with moderate symptoms such as,

• Local redness
• Swelling of the affected limb 
• Palpable and tender vein 
• Resolves in a few days or weeks 

Patients with DVT usually have more severe symptoms, including:

• Skin discoloration 
• Pain and tenderness
• Swelling of the affected limb 
• Higher risk of complications
  

Diagnosis

To effectively treat these conditions, it is essential to have the correct diagnosis. The symptoms that the patient presents with are the first clinical clue of what the diagnosis could be. However, oftentimes advanced clinical tools and tests are needed to further confirm the diagnoses. 

According to the Frankel Cardiovascular Centre at the University of Michigan, diagnosis of Superficial thrombophlebitis can be made through “the appearance of the affected area” and other tests such as an ultrasound ⁴.

Due to their complicated nature, DVTs require more tests to confirm a diagnosis. According to the National Blood Clot Alliance, a physician can diagnose a DVT by considering the patient's risk factors, symptoms, and results of certain tests^{. 5} . One of the most common tests used to diagnose DVTs is a D-dimer test. D-dimer proteins are found in the blood when a clot breaks down. When this test is above 0.50, it is considered a positive test ⁶. 

In addition to the D-dimer test, a Doppler ultrasound can be used to assist in the diagnosis of this condition. A study showed that Doppler ultrasounds are highly accurate at excluding calf DVTs in patients ⁷.

Treatment approaches

The treatment of STs is usually conservative and involves using a warm compress on the affected limb and taking mild painkillers such as NSAIDS ( anti-inflammatory drugs). Additionally, patients are encouraged to wear compression stockings and elevate the affected limb as often as possible. This can reduce the recurrence of clots ^{8 9}. 

Treatment for DVTs usually involves more medication as the condition is more severe. The first line of medication is usually anticoagulants. Some anticoagulants that have been proven to effectively treat DVTs include heparin and warfarin. The use of compression stockings is also encouraged, as well as lifestyle modifications that can be done when the patient has been discharged. Increasing mobility and maintaining adequate hydration levels will not only aid in weight loss but will also help reduce the risk of further blood clots. 

If these measures aren't enough to treat the DVT, surgery is necessary. Thrombolysis has been shown to have an 80-90% success rate.

Complications and prognosis

Superficial thrombophlebitis rarely has complications, and patients usually have a good prognosis. The most common complication is when STs become deep thrombophlebitis. Additionally, this condition has a good prognosis, with most symptoms subsiding within a few weeks and patients making a full recovery ¹².

Patients with DVTs might face possible complications which are potentially life-threatening. Pulmonary embolism is one of the main complications of DVTs and has a mortality rate of between 8 and 30% ¹⁰. Another possible complication is Post-thrombotic syndrome, which can sometimes lead to disability ¹¹. Despite the severity of this condition, most people will make a full recovery within weeks or months. This is only likely provided they receive adequate and proper treatment. However, recurrence still occurs in about 25% of patients ¹³.

Preventative measures

The saying “prevention is better than cure” rings true for both superficial and deep thrombophlebitis. Some key prevention strategies include:

• Staying well hydrated 
• Maintaining a healthy weight
• Avoiding prolonged sitting 
• Wearing compression stockings 
• Prophylactic anticoagulation medications 

Summary 

Superficial and deep thrombophlebitis are conditions caused by blood clots leading to vein inflammation. Superficial thrombophlebitis (ST) primarily affects veins close to the skin, such as the great saphenous vein. Symptoms include localised redness, a tender and palpable vein. On the other DVTs occur in deeper veins, resulting in symptoms like skin discolouration, pain, tenderness and an increased risk of complications. 

These two conditions have many overlapping risk factors such as obesity, varicose veins and smoking. However, the severity, treatment and prognosis of these diseases are widely different. STs can be managed conservatively with NSAIDs and compression stockings. Additionally, patients diagnosed with ST have a good prognosis, with many of the symptoms resolving in a few weeks. On the contrary, DVTs require anticoagulants and, in some cases, surgery to break up the causative blood clot. On top of that, it is not uncommon for patients to develop complications like pulmonary embolisation, requiring further hospitalisation. 

The increased risk of complications, coupled with the rise of high-risk patients, only highlights the importance of adopting preventive measures and early detection of these conditions.