Thrombophlebitis
Related Terms: blood clot, phlebitis, edema, vein obstruction, superficial thrombophlebitis, deep venous thrombosis, venous stasis, aseptic thrombophlebitis, septic thrombophlebitis, edema, lymphedema
Thrombophlebitis is an condition in which a blood clot and inflammation occurs in one or more veins close to the surface of the skin. Generally this is referred to as a superficial thrombosis versus deep venous thrombosis. It is extremely important to accurately assess this condition because an estimated 30% of patients with thrombophlebitis are subsequently diagnosed with deep venous thrombosis, which is life threatening.
Aseptic Thrombophlebitis
The most common form of thrombophlebitis. Aseptic thrombophlebitis types include primary hypercoagulable states - disorders with measurable defects in the proteins of the coagulation and/or fibrinolytic systems and Secondary hypercoagulable states - clinical conditions with a risk of thrombosis. Risk factors for aseptic thrombophlebitis are disorders that involve increased likelihood of blood clotting, infections, varicose veins, sitting or being immobilized for an extended period of time.
Septic Thrombophlebitis
More serious and potentially more life threatening form associated with either recent IV therapy (venous cannulation) or intravenous drug abuse.
Septic thrombophlebitis is an infected blood clot in a vein, which may be life-threatening. The effects of septic thrombophlebitis may include:(1)
Redness, swelling and tenderness of the skin overlying a vein
Pus draining from the vein
Septic clots in the blood vessels of the lungs (pulmonary emboli)
Bloodstream infections (septicaemia)
Treatment is with intravenous antibiotics. These should be broad-spectrum until cultures confirm the causative organism(s). If possible, the affected vein should be tied off and removed surgically.
Etiology and General Risk Factors:
Conditions that cause susceptibility to thrombophlebitis include varicose veins, medical conditions that lead to sluggish blood flow, pregnancy, patients undergoing intravenous injections, infections, as well as individuals who are immobilized or bed ridden. Other risk factors are the insertion of a vein catheter (pacemaker, chest port-a-cath), oral contraceptives and or hormone replacement medication, AIDS (lupus anticoagulant), Behcet disease, Buerger's disease, Mondor's Disease, blood type A, burns, chemotherapy, congestive heart failure, age, proteins C and S deficiency, trauma, ulcerative colitis.
Lymphedema and Thrombophlebitis
Because of the fibrosis associated with lymphedema, the recurrent episodes of cellulitis and due to the compression of the vascular system, there is a higher than normal risk of developing thrombophlebitis and or deep venous thrombosis. Your physician should regularly check venous flow in the lymphedema affected limb.
Clinical:
Pain in the area of the clotted vein, this may include tenderness to the touch
Redness of the surrounding or adjacent area
Swelling or edema in the surrounding skin
Complications:
The two most serious complications are pulmonary embolism and heart attack or stroke. Other complications involve damage to the veins in the leg and subsequent permanent venous pooling or swelling (edema), varicose veins, vein obstruction and permanent discoloration of the skin in the affected area.
The complications of septic thrombophlebitis include sepsis, septicemia, septic pulmonary emboli, abscess formation, pneumonia.
Pathophysiology:
In the absence of a triggering event, neither venous stasis nor abnormal coagulability alone causes clinically important thrombosis, but vascular endothelial injury does reliably cause thrombus formation. The initiating injury triggers an inflammatory response that results in immediate platelet adhesion at the site of injury. Further platelet aggregation is mediated by thromboxane A2 and by thrombin. Platelet aggregation due to thromboxane A2 is inhibited reversibly by nonsteroidal anti-inflammatory agents and irreversibly by aspirin, but thrombin-mediated platelet aggregation is unaffected by aspirin and nonsteroidals. This is why aspirin and nonsteroidal anti-inflammatories are somewhat effective in preventing arterial thrombosis, including stroke and myocardial infarction, but they are not very effective in preventing or treating venous thrombophlebitis. (1)
Diagnosis:
With the clinical features involved it is often easy to diagnosis thrombophlebitis from symptoms and appearance alone. However, because of the risk of deep venous thrombosis certain diagnostic tests become imperative. These tests include radiology examinations which include venous imaging, duplex ultrasound, magnetic resonance imaging, and invasive contrast venography, doppler study.
Other tests that may be used include the Perthese percussive test and the Trendelenburg test.
Differential Diagnosis:
Cellulitis, erythema nodosa, cutaneous polyarteritis nodosa, sarcoid, Kaposi's sarcoma, hyperanalgesic psuedothrombophlebitis
Treatment:
Treatments include medications (anti inflammatory medicine, anticoagulants), increased ambulation, compression stockings and focusing on causative factors (antibiotics for infections).
Other treatment modalities may include varicose vein stripping, insertion of a filter in the main vein in the abdomen (vena cava) and clot removal or bypass.
The edema associated with thrombophlebitis should subside upon treatment of the condition. If not, gentle decongestive therapy may be necessary.
Medications used in treatment might include IV heparin, warfarin, oxymetholone, antithrombin III, Stanozolol, ethylestrenol. Medications will be based on underling or complication medical conditions, type and severity of thrombophlebitis, whether aseptic or septic.
Prevention:
There are preventative measure that can be undertaken to lessen the likelihood of thrombophlebitis, these include
One long trips, getting up and walking around to keep circulation flowing.
If walking around is not possible, keep moving your legs, flexing the leg muscles.
Support garments that help promote fluid circulation and prevent edema.
Aspirin therapy may be prescribed. Aspirin affects the blood's clotting ability and can help prevent vascular coagulation
Prognosis:
Dependant upon the severity and underlying medical cause. Usually is quite good and the patient (in uncomplicated cases) should be relieved of symptoms from two to six weeks. Death from aseptic thrombophlebitis is rare.
For septic thrombophlebitis the mortality rates can be high if the condition is left untreated.
(c) Pat O'Connor - Lymphedema PeopleSuperficial Thrombophlebitis (ST)
What is superficial thrombophlebitis?
Superficial thrombophlebitis (ST, or SVT) is a condition in which inflammation causes a blood clot to form in a vein near the surface of the body. Often it develops in varicose veins, usually in the leg, pelvis, or arm. Varicose veins are enlarged veins close to the surface.
How does it occur?
ST occurs when irritation of a vein causes blood flow to slow down or stop, and a clot then forms in the vein. ST can occur after minor injury to a vein, for example, after a bruise or after you have had an IV (medicine or fluid given through a vein). It can also occur after excessive exercise.
What are the symptoms?
Symptoms of superficial thrombophlebitis may include:
tender cordlike vein that is very sensitive to pressure
redness and warmth in the area around the vein
swelling in the area around the vein.
How is it diagnosed?
Your health care provider will ask about your symptoms and examine you. He or she will be able to determine if you have ST from the physical exam. In some cases you may have special ultrasound or x-ray studies to check for clots in deeper veins.
How is it treated?
For treatment, your health care provider may recommend that you:
Take an anti-inflammatory drug, such as aspirin or ibuprofen.
Rest and elevate your arm or leg while you have pain and swelling, typically for 1 week.
Put warm, moist compresses on the inflamed area (be careful to avoid burns).
Elevate the affected arm or leg above the level of your heart when you are lying down.
How long will the effects last?
With proper treatment, ST usually lasts 1 to 2 weeks.
How can I take care of myself?
Follow your health care provider's instructions.
Ask if you may exercise in bed and how soon you may start taking daily walks.
If you have varicose veins, ask your health care provider if you should wear special support stockings.
How can I help prevent ST?
Because ST usually results from injury, it is hard to prevent.
University of Michigan Health System
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For further Information:
Thrombophlebitis - Medline Plus
Thrombophlebitis, Superficial (1) - eMedicine
The Circulatory System — Venous
posted by Pat O'Connor @ 10:43 AM
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