Thrombophlebitis

Thrombophlebitis is the formation of a thrombus in a vein accompanied by inflammation of the venous wall that can block the affected vein.

Thrombophlebitis happens when a clot or thrombus lodges in a vein and therefore the process is different than arterial thrombosis (when the thrombus lodges in an artery).

The word thrombophlebitis comes from phlebos = vein.

It is called phlebothrombosis when the formation of the thrombus occurs without inflammation of the venous wall, while in thrombophlebitis there is inflammation of the venous wall.

Thrombophlebitis generally occurs in the extremities, especially in the legs, and it can affect the deep or superficial veins.

Based on this, they are classified in the following way:

• Superficial venous thrombosis: It occurs in the superficial veins that are located between the muscle and the skin.
  
  They are common in the legs of people with varicose veins, but they can occur in the arms or anywhere else after the placement of an intravenous catheter, for example, to administer drugs or to perform an exam that requires venous catheterization.
  
  Other causes of superficial venous thrombosis are:
  • Use of intravenous drugs
  • Complications of sclerotherapy procedures (for removal of varicose veins)
  • Trauma that affects the veins (blows, burns, contact with chemical substances)
  • Skin infections that inflame the veins.
• Deep vein thrombosis (DVT): It occurs in the deep veins that are found between the muscle and the bone, usually in the thigh or calf.

Some diseases promote the appearance of both superficial and deep venous thrombosis even in people with healthy veins, such as some types of cancer and thrombophilia (excess formation of clots in the body for various reasons).

The main symptoms of thrombophlebitis are:

• Swelling (the vein feels hardened and can be palpated along its entire length) and pain in the affected area.
• Reddening or bruise, stinging and heat on the skin over the vein.

Diagnosis of the disease depends on the type:

• Superficial venous thrombosis: The thrombus and surrounding inflammation are usually visible on the skin.
  
  Sometimes it is repetitive, and changes in color can be observed on the skin, and even signs of infection where superficial thrombosis obstructs circulation.
  
  Doppler or duplex ultrasound allows the diagnosis of superficial thrombophlebitis with certainty.



• Deep venous thrombosis: It usually occurs in the legs, and it is suspected because the hardening of the vein persists even when the affected limb is elevated. In any thrombophlebitis with high and persistent fever, deep thrombosis should also be suspected.
  
  To reach the diagnosis, Doppler/duplex echo, an ultrasound study called plethysmography, or the injection of radiological or isotopic substances into the veins of the legs (phlebography) can also be used.

The main risk factors for developing thrombophlebitis are:

• Presence of varicose veins in the legs. The risk of venous thrombosis increases if any procedure has been performed to treat them, such as sclerosis or surgery.
• Frequent manipulation of the vein, either by catheterization, use of intravenous drugs, or any other puncture of the veins.
• Staying in bed for a long time, as occurs in patients who have undergone surgery, paralytics, etc.
• Very prolonged immobilization such as long car or plane trips, for example.
• Pregnancy and puerperium
• Obesity
• Cancer and oncological treatments
• Autoimmune diseases
• Use of contraceptives with an estrogen component
• Advanced age
• Family or personal history of diseases in which blood clotting increases

Superficial thrombophlebitis usually has a very good prognosis. Basically, its management is:

• Elevate the limb
• Start walking and moving as soon as possible to avoid prolonged stays in bed
• Place cold or warm compresses
• Pain treatment
• Wear compression stockings

Lately, it has been seen that superficial thrombophlebitis can affect the deep venous system and put the person's life at risk in some cases.

Therefore, prevention is being carried out in specific cases determined by the findings of Doppler or duplex ultrasound to provide anticoagulant medications.

It is very rare that any type of surgery is needed in these cases.

Deep thrombophlebitis or deep vein thrombosis has an associated danger: pulmonary embolism or pulmonary thromboembolism, a very serious event that must be treated from the first moment with anticoagulant medications.

It is generally started with heparin and then, when the acute phase has passed, an oral anticoagulant such as Warfarin or Acenocuomarol is used to prevent recurrence.

In some cases, a filter is placed in the main vein (the inferior vena cava) to catch clots before they reach the heart and lungs.