Phlebitis and Thrombophlebitis

Phlebitis is the inflammation of a vein that occurs in either the superficial (surface) veins closer to the skin, or in deep veins located within muscles. Phlebitis commonly occurs in the veins of the leg, but in rare occasions it may affect the veins of the arms or the neck. Thrombophlebitis occurs when the inflammation of the vein is caused by a blood clot. Phlebitis is often treatable and is usually not a serious condition, however in rare cases, a blood clot may travel to the blood vessels of the lungs, heart or brain, causing serious complications which can be fatal.

Causes of Thrombophlebitis

Thrombophlebitis may be caused by extended periods of inactivity; in some cases it may be the result of staying in bed during a long hospital stay or sitting for a long-period of time on an airplane flight. An injury to a vein may also cause a blood clot to form and the following factors may also increase a person's risk for developing thrombophlebitis:

  • Pregnancy
  • Birth control pills
  • Hormone replacement therapy
  • Smoking
  • Inherited blood-clotting disorder
  • Obesity
  • Increased age

Superficial thrombophlebitis may occur in people with varicose veins. Certain medical conditions or blood disorders may also increase the risk of blood clots and thrombophlebitis.

Symptoms of Thrombophlebitis

If phlebitis is mild, it may not cause any symptoms at all. Superficial thrombophlebitis affects the veins closer to the skin and may cause pain, swelling and tenderness in the affected area. The area may feel warm or hot to the touch and it may appear as a hardened, red area under the surface of the skin. Deep vein thrombosis, which affects larger and deeper veins, may cause pain, redness and swelling in the entire limb. If it affects the leg, it may cause difficulty walking. Some individuals with thrombosis may also experience fever, which may be a sign of an infection.

Complications of Thrombophlebitis

Serious complications of thrombophlebitis arise when the blood clot breaks off and travels through the circulatory system. This is called an embolism. When the clot travels to the lungs, it results in a pulmonary embolism. When it travels to the heart, it can cause a heart attack. If the clot makes its way to the brain, it can cause a stroke. Deep vein thrombophlebitis requires immediate medical care and individuals should seek treatment if they experience any related symptoms.

Diagnosis of Thrombophlebitis

Thrombophlebitis is diagnosed through a physical examination and a review of symptoms. Blood tests are performed to detect elevated levels of D-dimer, a clot-dissolving substance found in the blood which may indicate the presence of a clot. Imaging tests are also performed and may include:

  • CT scan
  • MRI scan
  • Ultrasound

A lower extremity venography may be performed to view the veins in the leg and detect blood clots. Blood coagulation tests, which measure the blood's ability to clot, may also be performed.

Treatment of Thrombophlebitis

Superficial thrombophlebitis is often treated with conservative methods that include applying heat to the affected area, elevation of the affected leg or limb, and over-the-counter nonsteroidal anti-inflammatory medications (NSAID). More severe cases, particularly those that progress to deep vein thrombosis, may require the following treatment:

  • Blood-thinning medications
  • Blood clot-dissolving medication
  • Compression stockings

If an individual also shows signs of an infection, antibiotics are prescribed. In some cases, when patients cannot be treated with medication, a filter may be temporarily inserted into the main vein of the abdomen, to prevent clots from traveling from the legs to the lungs. In severe cases, a surgical procedure may be performed to remove the clot and avoid permanent damage.

Prevention of Thrombophlebitis

While not all cases of phlebitis or thrombophlebitis can be avoided, there are simple precautions that can be taken to prevent the development of a blood clot in certain situations. When taking a long car or plane trip, walk or stretch your legs once in a while and drink plenty of liquids to stay hydrated. Lifestyle recommendations include:

  • Staying active
  • Don't smoke
  • Wearing support hose
  • Losing weight

Patients should also take any prescription anticoagulant medications as directed by their doctor, to prevent complications from occurring.