Superficial thrombophlebitis (superficial venous thrombosis)BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2039 (Published 22 June 2015) Cite this as: BMJ 2015;350:h2039
- H Nasr, specialist registrar,
- J M Scriven, consultant vascular surgeon
- 1Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK
- Correspondence to: J M Scriven
The bottom line
Superficial thrombophlebitis is usually a benign, self limiting disease, but consideration should be given to specialist referral for duplex ultrasound imaging and further management
Patients with limited (below knee) superficial thrombophlebitis without evidence of deep vein thrombosis can be safely managed in primary care with non-steroidal anti-inflammatory drugs and compression
Patients with thrombosis near the saphenofemoral or saphenopopliteal junction should be considered for surgical ligation or anticoagulation
Surgery should be considered in those with persistent symptoms or evidence of thrombus propagation despite medical treatment
Superficial thrombophlebitis (increasingly being called superficial venous thrombosis) is inflammation of the superficial veins associated with venous thrombosis. Traditionally, it has been considered a benign, self limiting disease of the lower extremity. However, it can affect most superficial venous systems in the body and importantly can be associated with deep vein thrombosis and pulmonary embolism. Treatment is aimed at symptomatic control and prevention of these serious and potentially fatal complications. Treatment options are variable and controversial.
How common is superficial thrombophlebitis?
The incidence of superficial thrombophlebitis remains unclear but is thought to be higher than that of deep vein thrombosis, which is estimated at about one per 1000.1 Although age is not an independent risk factor, the incidences of other risk factors increase with age, making superficial thrombophlebitis more common in older people, and more common in women (50–70%).2 3 4 However, complications are less likely in those over 60 years old.5
How is it diagnosed?
Superficial thrombophlebitis is a clinical diagnosis. Patients usually present with pain and discoloration (redness in the acute phase progressing to a brown, haemosiderin based pigmentation over days to weeks) over the affected superficial veins (fig 1⇓). On palpation, the vein is tender and hard. Extensive limb swelling should raise the suspicion of deep vein thrombosis rather than superficial thrombophlebitis.