Superficial venous thrombosis
Superficial venous thrombosis is thrombosis of a superficial vein, presenting as a tender, warm, palpable cord, often in a varicose vein. Once considered benign, extensive disease near the deep system carries a real risk of extension to deep vein thrombosis, so evaluation includes ultrasound and treatment may include prophylactic-dose anticoagulation.
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What this article covers
- Overview
Definition: superficial venous thrombosis (superficial thrombophlebitis) is thrombosis with inflammation of a superficial vein, most often in the lower limb and frequently in a varicose vein.
- Epidemiology
Common, especially in varicose veins and after cannulation.
- Risk factors
Varicose veins and chronic venous disease.
- Pathophysiology
Venous stasis and endothelial injury: stasis in varicosities or catheter-related injury triggers thrombosis with an inflammatory response.
- Clinical features
A tender, warm, erythematous, palpable cord along a superficial vein.
- Differential diagnosis
Deep vein thrombosis: limb swelling and deep tenderness, distinguished by thrombus in a deep vein on duplex rather than a palpable superficial cord (must be excluded).
- Diagnosis
Establish clinically and define extent with duplex ultrasound, excluding deep vein thrombosis: the diagnostic basis is the characteristic tender superficial cord confirmed on duplex ultrasound, which…
- Management
First-line, treat small, distal disease symptomatically: NSAIDs (ibuprofen 400 to 600 mg PO three times daily), warm compresses, compression stockings, and continued mobility.
- Complications
Extension to deep vein thrombosis and pulmonary embolism.
- Prognosis
Usually good, with resolution over weeks.
- Prevention
Manage varicose veins and chronic venous disease.
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