WHAT IS THROMBOPHLEBITIS?Thrombophlebitismeans phlebitis . Phlebitis is an inflammation in and around a superficial blood vessel, usually in the lower leg. Such phlebitis is caused by a clot in a superficial vein that drains the leg (a vein). The medical term for a clot in a blood vessel is thrombosis . Thrombophlebitis is also called superficial venous thrombosis. A clot can also develop in veins deeper in the leg, which is called deep vein thrombosis or thrombosis of the leg .
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| thrombophlebitis |
thrombophlebitis |
WHAT DOES THROMBOPHLEBITIS LOOK LIKE?With thrombophlebitis, or superficial vein thrombosis, a painful, red, warm, and hard-to-the-touch cord or spot develops quickly. This usually occurs in a previously present varicose vein. Thrombophlebitis is usually a few centimeters long, but it can also occur when the entire vein is clogged with clotted blood, along the entire length of the lower and/or upper leg. Superficial thrombosis is common, occurring an estimated 30,000 times per year in the Netherlands, and a similar number of deep vein thrombosis cases.HOW DOES THROMBOPHLEBITIS DEVELOP?Thrombophlebitis is caused by the formation of a clot in a superficial blood vessel. The clot attracts immune cells that attempt to eliminate the clot. This triggers an inflammatory reaction around the vessel. The overlying skin becomes red, warm, swollen, and painful.
A clot can form suddenly, without any apparent cause. However, sometimes there are clear underlying causes, known as risk factors for thrombosis. For example, the use of birth control pills. Thrombosis is also more common during pregnancy, in patients with prolonged hospital stays, around surgeries, after accidents, and in certain internal diseases where there are high levels of inflammatory proteins in the blood. Thrombophlebitis often develops in a varicose vein; this is because the blood in a varicose vein doesn't flow properly. A varicose vein is wide, and the valves that normally protect it have broken. As a result, the blood no longer flows properly back to the heart. A clot can easily form in sluggish or stagnant blood. There are also hereditary conditions that increase the risk of clotting.IS SUPERFICIAL VENOUS THROMBOSIS (THROMBOPHLEBITIS) DANGEROUS?Superficial vein thrombosis isn't dangerous; it's bothersome, but it usually resolves on its own. While the vessel is blocked, there are sufficient other superficial vessels in the leg through which blood can flow back to the heart. There's a 2-10% risk of the clot growing and forming in deeper vessels. This risk is especially high if the clot is close to a connection to the deeper veins or is longer than 5 cm. Deep vein thrombosis is a problem, however: these vessels are important for the return of blood to the heart. If they are completely blocked, a swollen, red, and warm swelling develops in the leg (a deep vein thrombosis). Another risk (in 1-4% of superficial vein thromboses) is that small clots can break free and travel via the heart into the pulmonary vessels. This can cause a pulmonary embolism, resulting in blocked pulmonary vessels and shortness of breath.
Clots in blood vessels can sometimes be cleared by the immune system, restoring the patency of the vessel. This clearing process usually also destroys the delicate valves within the vessel, or they no longer close properly because the vessel has widened. Consequently, after a previous thrombosis, varicose veins can develop in the superficial or deep veins.HOW IS THROMBOPHLEBITIS DIAGNOSED?The diagnosis is based on the clinical picture, its appearance. A painful, red, and hard cord is visible; not many other conditions exhibit this. Only lymphatic inflammation (lymphangitis) can mimic this, but that also presents with more symptoms (fever, feeling ill). A duplex ultrasound can be used to determine whether a clot is present in the vessel and whether this clot might be spreading to deeper vessels. If deep vein thrombosis (DVT) is suspected, a duplex examination is always performed. If thrombophlebitis occurs frequently, blood tests may be performed to detect hereditary or acquired clotting disorders.HOW IS THROMBOPHLEBITIS TREATED?For thrombophlebitis, a bandage or elastic stocking is usually applied. You must continue to wear this until the clot has dissolved, which usually takes two weeks. A small, newly formed clot can sometimes be expelled through a small incision. Anti-inflammatory painkillers such as diclofenac or ibuprofen may also be prescribed.
If there is a risk of the clot spreading deeper, anticoagulation is also initiated, usually in the form of an injection of fraxiparine twice a day. You can administer these injections yourself. A high risk of deep vein thrombosis exists if there are risk factors such as a previous thrombosis, underlying diseases, oral contraception, pregnancy, or clotting disorders; or if the clot is longer than 5 cm; or if the clot is within 5 cm of a connection to deeper vessels.WHAT CAN YOU STILL DO YOURSELF?There are few things you can do yourself to treat thrombophlebitis other than wearing stockings and taking anti-inflammatory painkillers. Exercise is good. Sitting still or lying in bed for long periods increases the risk of developing thrombosis. Treating varicose veins or wearing elastic stockings helps prevent this. Wearing elastic stockings during long flights, taking occasional walks, and staying active are also helpful. If you have a known risk of thrombosis, please inform us if you are admitted to the hospital: fraxiparine injections can be administered as a precaution to prevent thrombosis caused by bed rest. Applying heparin ointment (a drugstore product) or cold or warm compresses will not help.WHAT IS THE PROGNOSIS?Thrombophlebitis usually disappears completely after 2-4 weeks. A dark spot may appear on pigmented skin. |
