Superficial Thrombophlebitis
NICE CKS Superficial vein thrombosis (superficial thrombophlebitis). Last revised: Jul 2024.
Definition
Superficial thrombophlebitis (also known as superficial vein thrombosis) is the inflammation of a superficial vein associated with thrombus formation.
Aetiology
The most common risk factor is varicose veins (present in ~80-90% cases)
Other risk factors are similar to those of DVT:
| Hypercoagulability |
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| Endothelial damage |
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| Venous stasis |
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Clinical Features
Superficial thrombophlebitis mainly affects the lower limb
- Most commonly located in an area of pre-existing varicose veins
- Most commonly along the great saphenous vein
Typical features:
- A red, tender, palpable, firm lump / cord
- Associated itch / warmth / swelling
- Haemosiderin brown pigmentation may develop over the affected superficial vein
Recurrent or migratory superficial thrombophlebiti (esp. in non-varicose veins) should raise suspicion for underlying malignancy (Trousseau syndrome – classically associated with pancreatic cancer).
Complications
Key complications include:
- Progression to VTE
- Superficial thrombophlebitis recurrence or extension
- Infection (esp. if superficial thrombophlebitis is secondary to IV cannulation)
Investigation and Diagnosis
Superficial thrombophlebitis is usually a clinical diagnosis.
Consider an urgent venous duplex ultrasound to confirm the diagnosis if there is ANY of the following:
- Superficial thrombophlebitis affecting the proximal long saphenous vein
- Superficial thrombophlebitis at the saphenofemoral junction (at the thigh level)
- Extensive superficial thrombophlebitis (e.g. 5 or more cm or affecting both the thigh and the calf)
- Diagnostic uncertainty
Do not use a D-dimer blood test to diagnose suspected superficial thrombophlebitis.
Management
Emergency hospital admission is necessary if there is suspected concurrent DVT / PE.
Management:
| Symptom relief |
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| Graduated elastic compression stockings | Offer if arterial insufficiency has been excluded
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| Antibiotics | Consider oral / topical antibiotics if there are clinical signs of infection |
| Anticoagulation | DO NOT routinely offer anticoagulation
Consider if the superficial thrombophlebitis is within 3 cm of the saphenofemoral junction (due to high risk of progression into a proximal DVT) – seek specialist advice. |
If superficial thrombophlebitis is associated with a concurrent DVT (usually identified from ultrasound), therapeutic anticoagulation should be initiated.
See the Venous Thromboembolism (DVT and PE) article for more information.