Superficial Thrombophlebitis 

  • Author: Nelson S Menezes, MD, FRCS(Edin), FACS; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Feb 27, 2009
 

Background

Thrombosis or thrombophlebitis of the superficial venous system receives little attention in textbooks of surgery and medicine. However, thrombophlebitis is encountered frequently and, at times, can cause significant incapacitation. It is usually a benign self-limiting disease, but it can be recurrent and tenaciously persistent. At times, when affecting the greater saphenous vein, thrombophlebitis can progress into the deep venous system, which may lead to pulmonary embolism.

Superficial thrombophlebitis is an inflammatory reaction with thrombus of a vein under the skin. Distinguishing venous thrombosis from venous phlebitis can be challenging. Deep vein thrombosis (phlebothrombosis) can be asymptomatic, which means that thrombosis of the vein can be present without phlebitis. However, most of the superficial veins that develop thrombosis also have phlebitis, thus the term thrombophlebitis. Also, phlebitis is usually associated with thrombosis and an inflammatory reaction involving the vein.

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Pathophysiology

Although the etiology is frequently obscure, superficial venous thrombosis is most often associated with one of the components of the Virchow triad, ie, intimal damage (which can result from trauma, infection, or inflammation), stasis, or changes in the blood constituents (presumably causing changes in coagulability). Although superficial thrombophlebitis usually occurs in the lower extremities, it also has been described in the penis and the breast (Mondor disease). Superficial thrombophlebitis also occurs anywhere medical interventions occur, such as in the arm or neck (external jugular vein) from intravenous catheters.

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Epidemiology

Frequency

International

Superficial thrombophlebitis is a common condition worldwide.

Mortality/Morbidity

Death from superficial thrombophlebitis without complication is unusual; however, if superficial thrombophlebitis extends into the deep venous system, it can be the source of pulmonary emboli.

Sex

  • McColl and associates charted a possible risk of thrombophilia as a result of pregnancy, which could lead to superficial thrombophlebitis.[1] This is of concern to those women who carry the factor V Leiden or prothrombin C-20210-a genes, in whom a predisposition towards clotting is present.
  • Several studies indicate that oral contraceptives can increase the risk of thrombophlebitis. The risk of clotting is not well defined with more recent formulations of oral contraceptives with lower estrogen doses.

Age

  • In the author's experience, superficial thrombophlebitis most frequently occurs in the age group ranging from young adults to middle-aged persons.
  • However, Markovic and associates report that a common risk factor is age older than 60 years, but fewer complications occur in this age group.[2]
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Contributor Information and Disclosures
Author

Nelson S Menezes, MD, FRCS(Edin), FACS  Assistant Professor of Surgery, Weill Cornell Medical College; Chief of Vascular Surgery, Department of Surgery, Brooklyn Hospital Center

Nelson S Menezes, MD, FRCS(Edin), FACS is a member of the following medical societies: American College of Surgeons, International Society of Endovascular Specialists, Medical Society of the State of New York, and Society for Vascular Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Lawrence Kaufman, MD  Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine

Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Travis J Phifer, MD  Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport

Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, William A. Marston, MD, to the development and writing of this article.

References

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