(STP) is a widespread and controversial condition, since the pathophysiology of thrombophlebitis and deep vein thrombosis (DVT) are closely related.
Superficial thrombophlebitis begins with discomfort in the legs, the vein becomes hot. In the course of the vein, a condensation is felt, as if a cord was drawn through it.
Numerous studies have described risk factors for the development of superficial thrombophlebitis, many of which coincide with DVT factors. Varicose veins in the lower extremity in 93% of cases represent the most common predisposing risk factor. Other factors include age, female gender, obesity, recent surgery or immobilization, hormonal effects, the presence of previous venous thromboembolism (VTE), and malignant neoplasms. Seasonal fluctuations also affect the development of the disease, the peak incidence is usually observed in the warm summer months.
Risk of complications
For patients over the age of 60, with a history of DVT, recent immobilization, and systemic infection, the chance of developing deep vein thrombosis and concomitant thrombophlebitis is increased. Severe chronic and sudden onset of superficial thrombophlebitis, statistically significant risk factors for the development of VTE.
Diagnostic approach
Superficial thrombophlebitis is more common in patients with varicose veins, but can also occur in normal saphenous veins in patients with underlying thrombophilia. The prevalence of concomitant venous complications in patients with STP prescribes duplex scanning for each patient. The results of the study not only show the presence or absence of a blood clot, but also help in identifying complications. According to the results of ultrasound, we can say whether more advanced studies using tomography will be required.
Treatment options
The main goal of treating superficial thrombophlebitis is to prevent the expansion of blood clots and the risks of developing VTE. Many reference texts on vascular surgery and primary care continue to advertise bed rest as part of therapy for STP and DVT. However, the recommendation for bed rest for patients with acute thrombosis contributes to venous congestion, which is a trigger for a thrombus. Randomized trials have shown that compression and walking are better than bed rest to reduce swelling and discomfort, and to minimize clot expansion in patients with proximal DVT.
Compression therapy
Compression offers the most scientifically proven advantage for the treatment of superficial thrombophlebitis. This alleviates the symptoms and is also a prevention against the development of DVT. Decousus study confirms that compression therapy using gradient compression stockings or leg wraps is the current standard of care for patients with STP. A general rule of thumb applies to the compression gradient depending on the severity of venous insufficiency, skin changes and the presence of edema. The more severe the symptoms, the greater the degree of compression shown.
Anticoagulation and anti-inflammatory therapy
The prevalence of concomitant pathologies and the risk of complications in acute superficial thrombosis have led many researchers to use systemic anticoagulation. For example, low molecular weight heparin is recommended in prophylactic or intermediate doses for at least four weeks. Superficial thrombosis can be managed more conservatively, avoiding anticoagulation in favor of anti-inflammatory agents.
An acute inflammatory reaction is often observed with superficial phlebitis, and may raise concerns about a potential infectious process. Patients with purulent thrombophlebitis require drainage and the appointment of broad-spectrum antibiotics.
Surgical intervention
In cases of acute inflammation, soreness and fluctuations, a local incision and drainage are made. After cleaning and introducing local anesthesia, using a needle, make punctures in the changed places. This is a simple procedure, and after the punctures are done, the doctor can effectively drive out a superficial thrombus. The procedure significantly reduces inflammation and pain, with the added benefit of reducing the risk of severe hyperpigmentation over the affected area.