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Thrombophlebitis

Definition


Disease: Thrombophlebitis Thrombophlebitis
Category: Cardiovascular diseases
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Disease Definition:

Thrombophlebitis (may be shortened to phlebitis) is the case when a swelling occurs in one or more of the veins, especially the ones in the legs, and less commonly in the arms or neck, as a result of blood clots.

This condition usually develops due to immobility for an extended period of time, like bed rest after surgery or travel for a long time in plane. If the affected vein is right under the skin, the case is called superficial thrombophlebitis, but if it is buried in muscle tissues, it is called deep vein thrombosis (DVT), which causes serious complications if the clot becomes mobile (embolism) and starts circulating with the blood, since it may cause blockage of the pulmonary artery (pulmonary embolism).

There are several types of treatment for this disease ranging from preventive self-care methods to medication and surgery.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The symptoms of this disease might include:

 

  • Swelling and redness
  • Pain upon touching and warmth in the affected area


When a vein close to the surface of the skin is affected, a person may see a red, hard and tender cord just under the surface of his/her skin. When a deep vein in the leg is affected, the leg may become swollen, tender and painful, most noticeably when one stands or walks. A person may also have a fever. However, many people with deep vein thrombosis have no symptoms.

When noticing a hard, red, swollen or tender vein, medical care should be sought, especially if one's job requires immobility or if there is a family history of thrombophlebitis. Emergency medical care should be sought if the symptoms are severe and accompanied with shortness of breath or high fever, which might be indications of DVT, increasing the risk of mobile blood clots especially to the lungs.

Causes:

Susceptibility to thrombophlebitis is increased by the followings:

 

  • Immobility for a relatively extended period of time, such as when traveling, or mandatory rest after a heart attack, injury or surgery
  • Some types of cancer, such as in the case of pancreatic cancer that causes an increase of procoagulants in the blood, which are necessary substances for blood clotting.
  • Having a paralyzed arm or leg as a result of a stroke
  • Having a surgically installed pacemaker or having a catheter in a central vein that may decrease blood flow and irritate blood vessels
  • Being pregnant or having just given birth due to increased blood pressure in legs and pelvic veins
  • An increased probability of blood clot formation due to hormone replacement therapy or birth control drugs
  • Tendency or ease of blood clot formation in family history
  • Being obese
  • Having varicose veins
  • Smoking


In case a patient has more than one of the previously mentioned factors, a physician should be consulted about preventive measures, especially before long sessions of immobility

Complications

Complications:

Complications are rare when superficial veins are infected with thrombophlebitis. But the situation deteriorates in case of DVT, leading to more serious complications such as:

Pulmonary embolism:
This condition occurs when part of a deep vein clot becomes dislodged and gains mobility (embolism). It poses potentially fatal risks of blocking lung arteries.

Heart attack or stroke:
The risk of a heart attack or a stroke is increased when a mobile blood clot blocks any of the coronary arteries or blood vessels of the brain. This is especially hazardous in the case of having congenital heart defects like patent foramen ovale (PFO), an atrial septal defect or a ventricular septal defect.

DVT can also damage the valves of veins in the legs; these valves prevent backflow of the blood to the legs. This disruption of the valve function can cause the following problems:

Varicose veins:
Varicose veins may result in case the pooling of blood in the veins causes them to balloon.

Swelling:
A patient's leg may start swelling (edema) in case of severe blood accumulation.

Skin discoloration:
This condition is called stasis pigmentation; it occurs as a result of chronic swelling and increased pressure on the skin, causing skin ulcers in some cases, which require medical attention.

Blocked vein:
The blood flow in the vein may be permanently blocked due to deep vein thrombosis (DVT).

Treatments:

If the affected veins are superficial, treatment shouldn't take more than two weeks, without the need of hospitalization, where the patient is recommended some self care steps like elevating the effected leg, applying heat or using over-the-counter nonsteroidal anti-inflammatory drug (NSAID).

Thrombophlebitis, including deep vein thrombosis, may require some of these treatments:

Medications:
Medications are administered to make the blood thinner (anticoagulant), as in the case of heparin injections that prevents the clots from getting bigger, followed by warfarin treatment for several months that needs careful dosage decision, since it is a powerful drug and leads to serious side effects in case of dosage errors.

Support stockings:
In some cases, a prescription-strength support hose is recommended, since it reduces the potential risks of DVT and prevents the recurrence of swelling.

Filter:
In a surgical operation that doesn’t need an overnight stay in the hospital, a filter may be inserted into the main vein of the abdomen (vena cava) to prevent the clots that break loose from the leg veins from lodging in the lungs. This procedure is done in patients who can’t take anticoagulants (blood thinning medications).

Varicose vein stripping:
A doctor can surgically remove varicose veins that cause pain or recurrent thrombophlebitis in a procedure called varicose vein stripping. This procedure, typically done on an outpatient basis, involves removing a long vein through small incisions. Usually, the patient will be able to resume normal activities in two weeks or less. Removing the vein won't affect circulation in the leg because veins deeper in the leg take care of the increased volumes of blood. This procedure is also commonly done for cosmetic reasons.

Clot removal or bypass:
Sometimes, surgery is necessary to remove a clot blocking a vein in the pelvis or abdomen. To treat a persistently blocked vein, the doctor may recommend surgery to bypass the vein, or a nonsurgical procedure called angioplasty to open up the vein. Once angioplasty has opened up the vein, the doctor inserts a small wire mesh tube (stent) to keep the vein open.

Prognosis:

Not Available

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