Superficial thrombophlebitis, also called superficial venous thrombosis (SVT), is a pathological condition characterized by the presence of a thrombus in the lumen of a superficial vein, accompanied by inflammatory reaction of adjacent tissues.

Terminology

Some authors, however, reserve the term superficial venous thrombosis to the situation when there is thrombosis of a superficial vein without any associated inflammatory component ³.

Clinical presentation

Typically presentations include:

• tender erythematous areas overlying a superficial vein

  • may be warm to touch

  • there may be palpable mass/cord and surrounding edema

• visible distension of the vein proximal to the thrombosis

• there may be signs of chronic venous disease: visible varicosities, skin pigmentation, or palpable cords

Pathology

Like deep vein thrombosis (DVT), its occurrence is also related to Virchow triad.

Etiology

There are a large number of potential causes which does overlap with the causes of DVT ⁴:

• varicose veins (most common)

  • morphological changes that predispose to stasis and consequently to the development of thrombotic process

• prolonged immobilization

• surgery/trauma

• obesity

• hypercoagulable states, e.g. factor V Leiden thrombophilia ⁵

• oral contraceptive use

• past history SVT or DVT

• intravenous cannula or catheter use

• malignancies (see: Trousseau syndrome)

• autoimmune disease

• inflammatory conditions, in particular, Behcet disease and Buerger disease

Treatment and prognosis

Superficial thrombophlebitis is generally considered a self-limiting condition. However, concurrent deep venous thrombosis can be seen in 25% of cases. There is risk of superimposed infection.

Management depends on risk-stratification of the disease which is generally determined on the basis of underlying etiology, length of thrombosis and distance from the deep venous system:

• low risk (symptomatic management with topical or oral non-steroidal anti-inflammatory medications)

  • <5 cm in length and >3 cm from the deep venous system

  • associated with intravenous cannulation

  • no other risk factors for DVT or pulmonary embolism (PE) (see above)

• intermediate risk (typically prophylactic-dose anticoagulation e.g. 40mg enoxaparin subcutaneously or 10mg rivaroxaban orally once-daily)

  • >5 cm in length and >3 cm from the deep venous system

  • the presence of a risk factor for DVT/PE

• high risk (treatment-dose anticoagulation as per DVT/PE)

  • <3 cm from the deep venous system

  • propagation despite anticoagulation therapy given for an intermediate-risk SVT

Suggested treatment lengths include 45 days of intermediate-risk and 3 months for high-risk SVTs ^6,7.

See also

• Mondor disease