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Superficial vein thrombosis

Last reviewed: 10 Jan 2025
Last updated: 08 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • previous superficial vein thrombosis (SVT), deep vein thrombosis, or pulmonary embolism
  • redness/erythema of overlying skin
  • hot/warm overlying skin
  • painful/tender over affected vein
  • swelling/oedema of surrounding area
  • cord-like mass palpable
  • development of symptoms over hours to days
  • signs/symptoms of concomitant DVT or PE
Full details

Other diagnostic factors

  • varicose veins
  • history of thrombophilic disorders
  • autoimmune diseases (e.g., Behcet's and Buerger's disease)
  • recent vein instrumentation (e.g., sclerotherapy)
  • recent vein cannulation and intravenous drug administration
  • low-grade fever
  • pigmentation changes
Full details

Risk factors

  • varicose veins
  • thrombophilic disorders
  • autoimmune diseases (e.g., Behcet's and Buerger's disease)
  • prior history of superficial vein thrombosis (SVT)
  • female sex
  • sclerotherapy
  • intravenous catheterisation
  • malignancy
  • pregnancy
  • use of oral contraceptives (OCPs) and hormonal replacement therapy
  • older age
  • history of prior venous thromboembolism (VTE), including deep vein thrombosis and PE
  • obesity
  • prolonged immobilisation (e.g., long-haul air travel)
  • blood type
Full details

Diagnostic investigations

1st investigations to order

  • Doppler ultrasonography
Full details

Investigations to consider

  • biopsy
  • pulmonary CT angiography
  • ventilation perfusion (VQ) scan
  • conventional pulmonary angiography
  • assessment for malignancy
  • thrombophilia screening
Full details

Treatment algorithm

INITIAL

extension into the femoral vein or popliteal vein, thrombus ≤3 from the saphenofemoral or saphenopopliteal junction, or concomitant DVT or PE

ACUTE

non-pregnant: SVT ≥5 cm in length within axial superficial vein and >3 cm from the saphenofemoral or saphenopopliteal junction

non-pregnant: SVT <5 cm in length within axial superficial vein or thrombus within tributary varicose veins only

pregnant: SVT (any size) within axial or tributary vein

ONGOING

incompetent saphenous vein with associated varicose veins or recurrent SVT

Contributors

Authors

Sherry Scovell, MD, FACS

Vascular and Endovascular Surgeon

Massachusetts General Hospital

Assistant Professor of Surgery, Part Time

Harvard Medical School

Boston

MA

Disclosures

SS is an author for UpToDate, which is compensated. SS declares that she has no conflicts of interest with medical or pharmaceutical companies.

Acknowledgements

Dr Sherry Scovell would like to gratefully acknowledge Professor Vicky Tagalakis, a previous contributor to this topic.

Disclosures

VT has received reimbursement for advisory board work for Servier and Pzifer. Both of these companies are makers of anticoagulants. VT has received an investigator-initiated grant from Sanofi, manufacturer of Enoxaparin.

Peer reviewers

Francois Becker, MD, PhD

Consultant

Division of Angiology and Hemostasis

University Hospital of Geneva

Geneva

Switzerland

Disclosures

FB declares that he has no competing interests.

Michael Bromberg, MD, PhD

Professor of Medicine

Section of Hematology

Director of Hematologic Malignancies

Temple University School of Medicine

Philadelphia

PA

Disclosures

MB declares that he has no competing interests.

Louis Aledort, MD

The Mary Weinfeld Professor of Clinical Research in Hemophilia

Mount Sinai School of Medicine

New York

NY

Disclosures

LA declares that he has no competing interests.

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