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Superficial thrombophlebitis

Published by Bupa's health information team, May 2009.

This factsheet is for people who have superficial thrombophlebitis, or who would like information about it.

Superficial thrombophlebitis occurs if a superficial vein becomes inflamed and a clot forms in the vein. This isn't usually life-threatening and goes away on its own.

Animation - How superficial thrombophlebitis develops
About superficial thrombophlebitis
Symptoms of superficial thrombophlebitis
Complications of superficial thrombophlebitis
Causes of superficial thrombophlebitis
Diagnosis of superficial thrombophlebitis
Treatment of superficial thrombophlebitis
Prevention of superficial thrombophlebitis
Further information
Questions and answers
Related topics
Sources

How superficial thrombophlebitis develops

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About superficial thrombophlebitis

The superficial veins

Blood is pumped from your heart to your legs through arteries. Blood returns to your heart through your veins. The muscles in your legs help this upward blood flow. One-way valves help prevent blood from flowing back down your veins.

Just below the surface of the skin are the superficial veins. They are connected to deeper veins inside your leg by perforator veins.

Illustration of the deep and superficial veins of the leg
The deep and superficial veins of the leg

What is superficial thrombophlebitis?

Superficial thrombophlebitis occurs when a superficial vein becomes inflamed and a blood clot forms within the vein. It usually occurs in the leg but it may be in the arm or neck.

Symptoms of superficial thrombophlebitis

If you have superficial thrombophlebitis you may have some of the following symptoms.

Swelling of the calf or thigh in one leg.
Pain or tenderness.
A vein is hard when you touch it.
A vein has become bigger than usual.
Your skin may feel hot in the area (this is caused by inflammation).
Your skin may change colour, to red or purple, for example.
You may have a slight increase in body temperature.

Sometimes the vein can become infected or a larger blood clot forms. If you have this you may have the following.

Your symptoms may get worse.
The inner part of your thigh, towards your groin, may become inflamed.
Your whole leg swells.
Large areas of your leg become warm.
You get chest pains or develop breathing problems.

If you have any of these symptoms, you should contact your GP surgery urgently. If you develop chest pains and shortness of breath you should go to the hospital accident and emergency department.

Complications of superficial thrombophlebitis

Generally superficial thrombophlebitis doesn't have any complications and usually goes away in about two to six weeks. The vein may be raised and lumpy for longer than this. Sometimes the skin over the affected vein may change colour or a nodule may form in the area, which doesn't go away.

Thrombophlebitis may cause septic thrombophlebitis, which can be life-threatening. Septic thrombophlebitis generally occurs if there is a skin infection or you have had an intravenous drip. The infection then affects the whole body. Injecting illicit drugs into a vein can also cause septic thrombophlebitis. It can happen for no known reason. It may also be linked to certain infectious diseases such as syphillis.

If the clot moves up the vein in the leg, it can join with a deep vein and become more serious. If the clot moves towards your groin you should seek medical advice.

Causes of superficial thrombophlebitis

A clot can form because the wall of the vein is damaged, the flow of blood slows down or the medicines you may be taking are increasing the chance of your blood clotting.

Sometimes the flow of blood in the superficial legs can slow. This is caused by inactivity, which may be due to an injury, surgery or long periods of sitting. Certain conditions such as a stroke which limit movement can also increase the chance of developing thrombophlebitis.

The vein wall may be damaged due to trauma such as an injury. If you have recently had an intravenous drip in the vein you may be more likely to have thrombophlebitis, as some medicines can irritate the vein.

Varicose veins increase the risk of thrombophlebitis occurring as they are more likely to be damaged as they are swollen and blood flow can be slower. One to two in every four people who have untreated varicose veins are likely to develop superficial thrombophlebitis in their lifetime. If thrombophlebitis occurs in a varicose vein it may come back.

Pregnancy or recently giving birth increases the chance of developing superficial thrombophlebitis, particularly just after birth when you may not be moving around as much as usual. Increasing age and high blood pressure can also increase this risk.

An infection that you may develop from a central venous catheter, which is for injecting medicines such as during cancer treatment or for kidney dialysis, can increase the chance of developing thrombophlebitis.

The oral contraceptive pill and oestrogen treatments can increase the risk of thrombophlebitis.

Superficial thrombophlebitis is more likely if you have diabetes, if you have liver disease, if you are taking immunosuppressive medicines or if you have cancer or have difficulties absorbing nutrients.

Genetic conditions which increase the chances of your blood clotting can make it more likely that you can develop thrombophlebitis.

If you have previously had superficial thrombophlebitis, deep vein thrombosis, or have had pulmonary embolism before you are also more likely to develop superficial thrombophlebitis.

Diagnosis of superficial thrombophlebitis

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may organise tests to make sure you don't have deep vein thrombosis (DVT). These tests may include the following.

An ultrasound which uses sound waves to look for a blood clot in the vein. A specialised Doppler ultrasound may also be used to track the speed of blood through a blood vessel.
A dye may be injected into the vein to trace the path of the vein in the leg. This is called venography.
Magnetic resonance imaging (MRI) may be used to look at the blood vessels.

Treatment of superficial thrombophlebitis

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your GP's advice.

Self-help

Lifting your leg above the height of your heart when resting, as this can help increase the flow of blood through the leg and reduce swelling.

Ice packs may be helpful if the area is hot.

A warm compress such as a warm flannel over the vein may ease pain but there is no evidence that it works.

Keep active as this helps the blood flow around the body. Don't stay in bed.

Medicines

Painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen, are thought to be the most suitable type to use. Paracetamol is an alternative if you can't take NSAIDs, for instance during pregnancy or if you have a peptic ulcer.

An anticoagulant that stops the blood clotting called low molecular weight heparin (LMWH) may be useful. LMWH is given as an injection by a health professional to prevent a large clot forming causing a blockage in the vein. You may be given LMWH and NSAIDs together.

If you have a bacterial infection causing septic superficial thrombophlebitis, you may be given antibiotics such as flucloxacillin, erythromycin or clarithromycin. You will usually be given these medicines at your GP surgery but you may need to go to hospital for them. Most cases of superficial thrombophlebitis are not septic so you won't be given antibiotics and you won't need to go into hospital.

Ask your doctor for advice before taking medicines.

Non-surgical treatments

Your GP may prescribe compression stockings for superficial thrombophlebitis to compress the vein and stop the clot getting bigger. Wearing support stockings may reduce pain, increase the flow of blood and prevent the clot moving further down the vein or coming back but the evidence for this isn't clear. Compression stockings aren't suitable if you have arterial disease.

Surgery

This is only needed if the clot moves into the femoral vein.

If you have varicose veins and you continue to have superficial thrombophlebitis symptoms or you have a large number of varicose veins you may decide to have your varicose veins removed or treated.

Prevention of superficial thrombophlebitis

Try putting your legs above the height of your heart, do gentle exercise such as walking and avoid standing still for periods of time. Move your legs, particularly during long periods of sitting or resting. Your GP may prescribe compression (strong support) stockings for you to wear to prevent thrombophlebitis. Ask your GP for advice.

Discuss your personal and family history with your GP before starting hormone treatments to prevent thrombophlebitis.

Further information

The Circulation Foundation
020 7304 4779
www.circulationfoundation.org.uk