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THROMBOPHLEBITIS
Thrombophlebitis (throm-bo-fluh-BI-tis) occurs when a blood clot and inflammation develop in one or more of your veins, typically in your legs. On rare occasions, thrombophlebitis (phlebitis) can affect veins in your arms.
The affected vein may be near the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombophlebitis).
The cause often is prolonged inactivity, such as sitting during a long period of travel in an airplane or automobile or lengthy bed rest after surgery. The inactivity decreases blood flow through your veins and may cause a clot to form. Paralysis, certain types of cancer and use of the hormone estrogen also may lead to thrombophlebitis. An inherited tendency for blood clots places you at higher risk of thrombophlebitis.
Signs and Symptoms
- Warmth, tenderness and pain in the affected area
- Redness and swelling
When your deep veins are affected, your leg may become tender, painful and swollen. You may also have a fever.
When a superficial vein is affected, a red, hard and tender cord may be present under the surface of your skin.Risk Factors
Your risk of thrombophlebitis increases if you:
- Are inactive for a long period of time, such as sitting in a car or an airplane
- Are confined to bed for a prolonged time, such as after surgery, a heart attack or a leg fracture
- Have certain types of cancer, which may result in an increase in your blood procoagulants, substances necessary for blood coagulation
- Have had a stroke resulting in paralysis of your arms or legs
- Have a pacemaker or have a catheter in a central vein, which may decrease your blood flow
- Are pregnant or have just given birth, which may mean you have increased pressure in the veins of your pelvis and legs
- Use oral contraceptives or hormone replacement therapy, which may increase the clotting factors in your blood
- Have a family history of a tendency for blood clots
When to Seek Medical Advice
See your doctor if you have a red, swollen or tender vein. In case the reason for the vein inflammation is a clot, you want to seek medical attention urgently, before the clot completely obstructs your vein or dislodges and causes other serious health problems.
Diagnosis
Your doctor may be able to diagnose superficial thrombophlebitis based on the discomfort you've experienced and by examining the vein near the surface of your skin. To diagnose deep vein thrombophlebitis, your doctor may choose one of these methods:
- Ultrasound. A wandlike device (transducer) placed over your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect back, a computer transforms the waves into a moving image on a video screen. A clot may be visible in the image.
- Venography. A contrast agent (dye) is injected into a large vein in your foot or ankle. An X-ray procedure creates an image of the veins in your legs and feet, possibly revealing clots.
Complications
If thrombophlebitis is in a superficial vein just under your skin, serious complications are rare. However, if the clot occurs in a deep vein, the risk for serious complications is significant. If part of a deep vein clot becomes dislodged, it may travel to your lung, where it may block an artery (pulmonary embolism) and cause a potentially life-threatening situation.
A deep vein thrombosis may also damage valves in the veins in your legs. Because veins don't have muscle in their walls to help pump the blood back from your legs to your heart, they are affected by gravity and by the gentle squeezing provided by the surrounding muscle. To improve the flow of blood back to the heart, veins have valves. The valves in the veins prevent the blood from flowing back as it is gradually pushed uphill toward the heart.
When the valves in the veins of your legs don't work properly, several problems can occur. The pooling of blood can lead to ballooning of the vein, resulting in varicose veins. In some cases, the pooling may become so bad in a condition called venous insufficiency that your leg swells. With chronic swelling and increased pressure on your skin, discoloration called stasis pigmentation may occur. In some cases, skin ulcers may develop. If you have several episodes of deep vein thrombophlebitis, a permanent obstruction could develop in the vein.
Treatment
If thrombophlebitis occurs in a superficial vein, your doctor may recommend self-care steps that include applying heat to the sore area, elevating your leg and using a nonsteroidal anti-inflammatory drug. The condition usually subsides within 5 days.
If you have deep vein thrombophlebitis, injection of an anticoagulant medication, such as heparin, will prevent clots from growing. The availability of a type of heparin called low molecular-weight heparin has allowed treatment without hospitalization. After heparin treatment, taking the anticoagulant warfarin (Coumadin, Panwarfin) for several months continues to prevent clots from growing. Anticoagulant medications prevent clots from growing. Sometimes, a drug to dissolve the clot is needed. Your doctor also may recommend prescription-strength support hose to prevent recurrent swelling and to reduce the chances of complications of deep vein thrombophlebitis.
In rare instances, insertion of a filter into the main vein in your abdomen (vena cava) is needed to prevent clots that break loose in leg veins from lodging in your lungs.
Prevention
Sitting during a long flight or automobile ride can cause swollen ankles and calves. The inactivity also increases your risk of thrombophlebitis in the veins of your legs. To help prevent a blood clot from forming:
- Take a walk around the airplane cabin once an hour or so. If you're driving, stop every hour or so and walk around the car a couple of times.
- Flex your ankles or press your feet against the seat in front of you.
- Wear support stockings. They compress your legs to help promote circulation and fluid movement. Wear them if you're prone to swollen legs and ankles.
- Take aspirin. If you're not allergic to aspirin, consider taking an aspirin just before a long trip to help prevent clot formation.
Self-Care
If you have superficial thrombophlebitis:
- Apply heat to the involved area.
- Elevate your leg.
- Use a nonsteroidal anti-inflammatory drug.
If you have deep-vein thrombophlebitis:
- Elevate your leg.
- Apply heat to your calf to relieve pain and swelling.
- Take prescription anticoagulant medications to prevent recurrences and complications.
- Wear your prescription support hose daily.
Thomas G. Stovall, M.D.
Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women's Health Specialists, Inc.
Date Published: 2004-03-23
7800 Wolf Trail Cove, Germantown, TN 38138
Phone: (901) 682-9222; Fax: (901) 682-9505