Ultrasound proven superficial thrombophlebitis

This leaflet provides information for patients with ultrasound proven superficial thrombophlebitis.

What is superficial thrombophlebitis?

Superficial thrombophlebitis is inflammation of a vein just under the skin, usually in the leg. A small blood clot also commonly forms in the vein, but is usually not serious. The condition often settles and resolves within two to six weeks. A typical site is in a varicose vein in a leg, varicose veins are common, particularly in pregnant women. Treatments can ease pain or discomfort. Superficial thrombophlebitis is different to, and much less serious than, deep vein thrombosis. However, in a small number of cases, complications can occur with superficial thrombophlebitis including extension of the blood clot further up the vein. If the clot extends to where the superficial and deep, larger veins join, a deep vein thrombosis can develop.

What is thrombophlebitis?

Phlebitis means inflammation of a vein.

Thrombosis means a blood clot in a vein.

A vein is a blood vessel that takes blood towards the heart. If a vein becomes inflamed, a blood clot commonly forms inside the inflamed portion. So, the term thrombophlebitis is used to mean an inflamed vein, with or without a small blood clot inside the vein.

What causes superficial thrombophlebitis?

Many cases occur for no apparent reason but even a slight injury to the vein may trigger the inflammation in some cases.

Risk factors

There are a number of risk factors that make it more likely for inflammation to develop in a vein:

• Varicose veins - many cases occur in people who have varicose veins of the legs. Varicose veins are prone to minor injuries which can lead to inflammation.
• Intravenous injection or cannulation - sometimes it occurs after having intravenous injections (injections into the veins) or intravenous infusions ('drips') in hospital. These are commonly given in hand or arm veins. Such procedures can injure the vein and may trigger inflammation. Damage to the veins in this way is also common in people who inject 'street drugs'.
• Previous problems with veins - if someone has had previous superficial thrombophlebitis or a previous DVT, they are more likely to get superficial thrombophlebitis.
• Abnormalities of blood clotting factors - various conditions can alter certain chemicals ('clotting factors') in the bloodstream, which make the blood clot more easily. These include: using the oral contraceptive pill, using hormone replacement therapy, cancer, smoking, and pregnancy. There are also some less common hereditary blood disorders where blood clots develop more readily than usual.
• Blood flowing more slowly than normal (stasis) - this might occur in varicose veins, during long flights, or in people who are immobile, and also following major surgery.
• Previous problems with veins - if someone has had previous superficial thrombophlebitis or a previous DVT, they are more likely to get superficial thrombophlebitis.
• Abnormalities of blood clotting factors - various conditions can alter certain chemicals ('clotting factors') in the bloodstream, which make the blood clot more easily. These include:
  • using the oral contraceptive pill
  • using hormone replacement therapy
  • cancer
  • smoking
  • pregnancy

There are also some less common hereditary blood disorders where blood clots develop more readily than usual.

What are the symptoms of superficial thrombophlebitis?

Swelling, redness, and tenderness along a part of the vein are the usual symptoms. You may develop a fever (high temperature). If a blood clot develops inside the inflamed part of the vein, the vein may then feel hard or knobbly. The blood clot is usually of little concern, as it is small. There are other veins which carry the blood, and bypass the blocked vein.

When the inflammation settles, a persistent darker area of skin (hyperpigmentation) may remain over the affected vein. A small firm lump may also persist below the skin. This may be tender to the touch for some time.

What is the treatment for superficial thrombophlebitis?

Most bouts of superficial thrombophlebitis last for three to four weeks. If they are associated with varicose veins, they are likely to recur. No treatment may be needed if the symptoms are mild. One or more of the following treatments may be advised, depending on your symptoms and the severity of the condition:

• Keep active. Try to keep up your normal activities. This should be possible unless the pain is severe.
• A hot flannel (cloth) placed over the vein. This may ease the pain.
• Painkilling tablets. Anti-inflammatory painkillers such as Ibuprofen may ease the pain (but are not advised if you are pregnant). Paracetamol is an alternative as some people may not be able to take anti-inflammatory painkillers.

Check with your doctor or pharmacist. Always read the packet leaflet that explains possible side-effects. There is also some evidence that anti-inflammatory tablets may reduce the risk of superficial thrombophlebitis enlarging or extending within a vein and/or it coming back.

• Anti-inflammatory creams or gels. An example is Ibuprofen gel. These are an alternative if superficial thrombophlebitis is mild and only affects a small area of vein. They tend to produce fewer side-effects than those taken by mouth.
• Hirudoid® cream (heparinoid) may improve your symptoms, although there is some evidence that heparin gel may be more effective but needs a prescription from your GP.
• Raising the affected leg. When you rest, if you raise an affected leg so that your foot is higher than your hip higher than your hip, it helps to reduce swelling and discomfort. You can do this by lying on a sofa and putting the leg up on some cushions.
• Compression (support) stockings. These may be advised by your doctor if a vein in your leg is affected. They may ease discomfort and reduce swelling whilst the inflammation settles.
• Anticoagulation Depending on the extent of your superficial thrombophlebitis you may be referred for medical assessment and a course of daily anticoagulant injections or tablets prescribed. The aim of treatment is to improve symptoms, reduce the risk of thrombus extension and risk of deep vein thrombosis.

Are there any complications from superficial thrombophlebitis?

The inflammation and pain usually settle within a few weeks. Most people make a full recovery. The possible complications listed below are uncommon, but are listed to give guidance on what to look out for. See a doctor as soon as possible if you suspect that a complication is developing.

Infection

Sometimes the affected vein becomes infected. The pain may then become worse, and the redness spreads. You are likely to feel generally unwell. Antibiotics may be needed to treat infection.

Blood clot extension

In some cases, the blood clot can extend further up the vein. If the clot extends to where the superficial and deep veins join, a DVT can develop. This is more likely if the superficial thrombophlebitis is in the upper thigh or the groin, near to where the superficial veins and the deep veins of the leg meet. There is a similar meeting point of superficial and deep veins at the crease behind the knee. It is also more likely to occur if superficial

thrombophlebitis develops in a previously normal vein (not a varicose vein), if you have had a DVT before, or if you are immobile for some reason.

See a doctor urgently if:

• Inflammation, redness, or hardness spreads up your inner thigh towards your groin or is around the back of your knee or calf.
• Your whole leg swells.
• Pain becomes suddenly worse.
• You develop any new breathing problems, or get chest pains. Sometimes a clot from a DVT breaks off and travels to the lung.

Recurrent superficial thrombophlebitis

It is common for people with varicose veins to get recurrent bouts of superficial thrombophlebitis. However, for a small number of people this may be the first sign of a more serious condition. Tests may be advised if there is no obvious explanation for recurring bouts of superficial thrombophlebitis.

References and sources of evidence

• Patient Info - Superficial thrombophlebitis: Symptoms, Treatment, and Prognosis (opens in a new tab) (Oct 2021).
• NICE - Superficial vein thrombosis (superficial thrombophlebitis) (opens in a new tab). NICE CKS (March 2020)
• Di Nisio M, Wichers IM, Middeldorp S; Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2012 Mar 14;3:CD004982
• Menezes NS, Superficial Thrombophlebitis, Medscape, Mar 2012
• Torpy JM, Burke AE, Glass RM; JAMA patient page. Thrombophlebitis. JAMA. 2008 Oct 8;300(14):1718

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