Superficial Thrombophlebitis Some Grounds For Concern

Superficial thrombophlebitis can be worrying and uncomfortable. What does it indicate? Will it occur again?

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As its name implies it is in or near the surface. Thrombus or clot is present in the vein. It is inflamed.

Usually therefore it will present as a red, tender and hot or warm ropey lump immediately under your skin.

Superficial thrombophlebitis of inner thigh to knee with typical red inflamed flare about it

Central intense redness of the involved vein with surrounding increased blood flow

If the vein was quite tortuous before it may feel more like a series of lumps.

In Otherwise Normal Veins

Sometimes it can occur after intravenous administration of certain medications.

These irritate the vein lining and cascade to closing it off with a small localised clot.

In Varicose Veins

Aside from this it occurs most often in varicose veins.

Why?

As with deep vein clots, people who have a increased risk of blood clotting are more likely than most people to get superficial clots.

Other medical conditions that provoke clotting will increase the risk. I will cover this elsewhere.

Apart from these provoking factors two other situations can produce them.

Provoking Factors

A knock or other injury over a varicose vein can cause one to arise.

People wearing flight socks to prevent deep vein clots can paradoxically suffer from them. If the surface varicose veins occur about the back of your knee.

As flight socks tend to be knee high in length, the top border is at knee level.

Sitting for hours with this effective local band across the back of your knee impedes that already compromised surface vein circulation.

Dynamic Factors

Which brings up the other reasons superficial thrombophlebitis occurs in varicose veins.

As the blood in varicose veins circulates poorly it tends to be more prone to clotting.

For many years blood sitting at rest as opposed to continuously flowing has been known to clot more readily.

Looking at varicose veins in ultrasound imaging you can see how the blood cells tend to cluster together without the turbulence of continuous normal flow.

Watching this it seems almost inconceivable that blood would not clot. It’s a wonder it does not do so more often.

Inflammatory Component

The discomfort, redness and heat of inflammation that occurs with superficial thrombophlebitis and gives it its name actually occurs after the local clot has formed.

Brought on by the body’s defences and remodelling to deal with it. Most often to break it down and allow the blood to flow through the vessel again.

The inflammatory process produces a locally increased circulation, fluid and cells in the area as these defences are mobilised.

It tends to make the area more swollen and obvious than just with the initial clot.

Normal Progression

Most often these localised surface vein thromboses stay localised to a short segment.

Over time the body breaks them down. Blood flows again.

The vein returns to its continued, though maybe ineffective, functioning.

Extension Of Superficial Thrombophlebitis

Progressive extension of the clot is cause for concern. More as it approaches connections to the deeper veins.

These extensions are usually in the saphenous veins, below the surface, just on top of the muscle but still part of the superficial system.

Here it could release a tongue or piece of the clot or thrombus into the deeper circulation. As with the risk of deep vein clots this can produce serious side effects to even being life-threatening.

Alternatively the growing clot can continue to extend into the deep circulation producing a true deep vein clot.

Treatment Options

Treatment of superficial thrombophlebitis will vary according to whether it remains localised or extends.

Knowing what it is, simply watching its progress to resolution may be all that is required.

Anti-inflammatories

Often you might be given an anti-inflammatory medication to control the discomfort and degree of inflammation. This is more for the symptoms.

Sometimes they are given as skin applied creams.

Once the inflammation has settled you will still be able to feel a lump present. This slowly resolves as your body remodels it.

Antibiotic Use

Often I find people are given antibiotics as the area is red and hot.

It is very rare for infection to be present. Neither are you really at risk of infection occurring in it.

They do not change the outcome.

Direct Release

It is possible to release the localised clot by placing a small cut in the vein and expressing the clot.

It will be tender to do. It is not a common choice.

But once done it can give rapid relief.

In Thrombophlebitis Extension

If there is concern about the clot extending, you may well be managed with a compression stocking and possibly injectable heparin medication.

Progression will be monitored by ultrasound.

Early Treatment Option

One possible option is to treat the underlying varicose vein problem to prevent extension.

Some will debate this choice.

But it is a viable option. It immediately decreases discomfort.

The only downside is the area of superficial thrombophlebitis cannot be effectively treated at the time and will likely need some later touch up work.

But in doing the definitive treatment it will prevent similar problems occurring.

Usually a superficial thrombophlebitis incident is sufficient grounds for insurance cover for your varicose veins treatment.