What Is Superficial Thrombophlebitis?

  • Grace Russell PHD Researcher at University of the West of England
  • Richa Lal MBBS, PG Anaesthesia, University of Mumbai, India

Superficial thrombophlebitis, also known as superficial vein thrombosis (SVT) is a disease of veins or vein inflammation that is generally not serious and can be resolved on its own within a week or two. In much simpler terms, you can understand the term thrombophlebitis by breaking the words into three parts: 

  1. SUPERFICIAL: Situated or occurring on the skin or immediately beneath it.
  2. THROMBUS: Blood clot formation in the circulatory system, which can hamper the blood flow into the veins.
  3. PHLEBITIS: Any term having “-itis” at the end of a medical disease always means inflammation of a particular organ or area involved. Hence, in this case, it signifies inflammation of veins.

In this article, the terms superficial thrombophlebitis and SVT will be used interchangeably and are similar in terms of meaning and definition. Although it often affects the lower limbs or legs, phlebitis can also infect the arms or neck.1 Out of all the veins in the legs, the great saphenous vein (GSV) also called the long saphenous vein is most commonly affected in 60-80% of the cases and in 10-20% of individuals the short saphenous vein is involved.2,3

Note: Blood vessels in your legs called saphenous veins assist in returning blood from your legs and feet to your heart. Each of your legs has two main veins that are great/long and short saphenous veins.

Although SVT is a self-limiting condition, it is no longer accepted that superficial thrombophlebitis is a benign condition. It is frequently accompanied by concurrent deep venous thrombosis (DVT) which simply means blood clot formation in deeper veins.1 In the UK, DVT affects about 1 out of every 1,000 people every year.  Moreover, when a blood clot fragment breaks off and enters the bloodstream, it can lead to a more serious and life-threatening condition known as pulmonary embolism (PE). This condition can be fatal because one or more of the lungs' blood vessels become blocked, preventing oxygenated blood from getting to the lungs.  As a result, more severe symptoms such as breathlessness and/or chest pain can be observed in extreme cases.

According to one study, what constitutes the best course of action for superficial thrombophlebitis of the legs is still unclear. The goal of treatment should be to prevent venous thromboembolism, which could alter the course of superficial thrombophlebitis, whilst also reducing or eliminating the local unpleasant symptoms like pain and tenderness in the affected areas.4  

This article discusses how you can identify the risks and causative factors of SVT, superficial and deep venous thrombosis screening and treatment, emphasising how you can also prevent and diagnose yourself whether you have superficial thrombophlebitis.

Overview

Superficial thrombophlebitis is the unexpected appearance of swelling or inflammation of the veins, especially in your lower limbs. Symptoms are typically short-lived and, in most cases, disappear without any treatment. However, in severe cases, consultation with a GP or nurse is advised. 

Causes of superficial thrombophlebitis

There are several causes, and diagnosing the exact cause always remains unclear. The most common cause is varicose veins, which manifest in two different ways. It is distinguished by a significant blood clot formation in a varicose vein and a mild inflammatory response that is restricted to the vessel wall but not the surrounding tissue. Rarely does SVT impact a vein that isn't varicose.5  

Any veins in the legs and feet that appear bulging and swollen are indicative of varicose veins. The affected veins are frequently lumpy, bloated, or knotted in appearance and can be blue or dark purple.

Signs and symptoms of superficial thrombophlebitis

Some of the most common superficial thrombophlebitis symptoms  that can be a sign that you might be developing an infection in your lower limb are:

  • Limb pain, irritation, or inflammation in the afflicted area
  • The skin around the affected area is heated and itching
  • Changes in the surrounding skin's colour and texture, such as a reddish hue and a hard, dense feel

Management and treatment for superficial thrombophlebitis

Management differs depending on extent and severity, but below are some effective ways to treat SVT:

  • Referral for specialist assessment, such as a GP or practice nurse, if a serious form of SVT is suspected. For instance, referring a patient to a vascular service for scanning to help determine the best course of treatment and whether additional specialised intervention may be necessary
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin may be given for pain management and antibiotics in case of infection. Paracetamol may also be used for pain relief
  • Providing the proper self-care instructions, such as applying a warm, damp towel to the affected limb and raising the affected leg when seated, is likely to provide relief in most cases
  • People having recurrent episodes of SVT should be checked for the presence of any kind of blood coagulation

FAQs

How is superficial thrombophlebitis diagnosed?

A physical examination of thrombotic veins by a GP or nurse practitioner can be used to diagnose superficial thrombophlebitis. Patients typically have pain and discolouration over the affected superficial veins. The vein is painful and firm to the touch. Significant limb enlargement rather than superficial thrombophlebitis should prompt concern about deep vein thrombosis. 6

A compression ultrasonography examination is advised to detect simultaneous DVT, assess the thrombus's size, and establish the diagnosis.1,7

How can I prevent superficial thrombophlebitis?

The most common way you can prevent superficial thrombophlebitis is adequate movement. Avoid holding your arms and legs stationary for extended periods whenever you can. On lengthy flights or road trips, stretch your legs frequently or go for exercise. Don't sit or lie down for extended periods without doing any kind of movement. 

Who is at risk of superficial thrombophlebitis?

The majority of patients with SVT are outpatients, mostly people assigned female at birth, with a mean age of 60, a high body mass index, and/or a history of varicose veins.2

How common is superficial thrombophlebitis?

Although the prevalence of superficial thrombophlebitis is largely unknown, it is assumed to be comparable with deep vein thrombosis, which is expected to occur in roughly one in a thousand people.  Superficial thrombophlebitis is more common in elderly people and is 50-70 times more prevalent in people assigned female at birth.6 However, with increasing age, the incidence of SVT becomes more common regardless of gender.4

When should I see a doctor?

  • When the signs and symptoms of SVT do not disappear in a week or two
  • If the pain becomes unbearable
  • If the affected area changes colour from red to hyperpigmented or dark brown
  • You have severe swelling affecting both of your lower legs
  • If you have any problems with breathing or chest pain

Summary

A blood clot that develops in a vein just below the skin's surface, generally in the legs or arms, is known as superficial thrombophlebitis. In the affected area, this may result in discomfort, redness, swelling, and warmth. A few weeks usually pass before superficial thrombophlebitis heals on its own.

Although it is typically not a dangerous condition, if the clot grows or moves into the deeper veins, it can cause more severe consequences, including DVT. Compression stockings, painkillers, and occasionally blood thinners are used as treatments in most cases. 

References

  1. Czysz A, Higbee SL. Superficial thrombophlebitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2023 Mar 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK556017/
  2. Décousus H, Bertoletti L, Frappé P. Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat? Journal of Thrombosis and Haemostasis [Internet]. 2015 Jun [cited 2023 Mar 3];13:S230–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1538783622042222
  3. Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Vascular Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 25 [cited 2023 Mar 3];2018(2). Available from: http://doi.wiley.com/10.1002/14651858.CD004982.pub6
  4. 613. Frappé P, Buchmuller‐Cordier A, Bertoletti L, Bonithon‐Kopp C, Couzan S, Lafond P, et al. Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community‐based study. Journal of Thrombosis and Haemostasis [Internet]. 2014 Jun [cited 2023 Mar 3];12(6):831–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1538783622039642
  5. Blättler, Schwarzenbach, Largiadèr. Superficial vein thrombophlebitis – serious concern or much ado about little? Vasa [Internet]. 2008 Feb 1 [cited 2023 Mar 3];37(1):31–8. Available from: https://econtent.hogrefe.com/doi/10.1024/0301-1526.37.1.31
  6. Nasr H, Scriven JM. Superficial thrombophlebitis (Superficial venous thrombosis). BMJ [Internet]. 2015 Jun 22 [cited 2023 Mar 3];350(jun22 6):h2039–h2039. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.h2039
  7. Canty D, Mufti K, Bridgford L, Denault A. Point‐of‐care ultrasound for deep venous thrombosis of the lower limb. Australas J Ultrasound Med [Internet]. 2020 May [cited 2024 Jan 16];23(2):111–20. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ajum.12188
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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