Superficial vein thrombosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Aug 2025

Last updated: 08 Mar 2024

Superficial vein thrombosis (SVT, also known as superficial vein thrombophlebitis) of the lower limb is most often a complication of varicose veins.

Doppler (duplex) ultrasonography is recommended for all patients with suspected SVT of the lower limb, as concomitant deep vein thrombosis (DVT) may be present.

Underlying prothrombotic conditions should be sought in cases of recurrent SVT and migratory SVT, especially in the absence of varicose veins.

Anticoagulation for 45 days to prevent venous thromboembolic complications (DVT or pulmonary embolism) is warranted, especially in patients with SVT of 5 cm or greater in length.

Definition

SVT refers to thrombus formation in a superficial vein, and inflammation in the tissue surrounding the vein.[1] It is generally characterized by pain, tenderness, induration, and/or erythema in a superficial vein. There is often a palpable, sometimes nodular, cord with warmth and erythema, which suggests the presence of thrombus. It most often occurs in the saphenous vein of the lower limbs, and its tributaries. It can also occur in the veins of the upper limbs or neck, but this is less common and usually due to intravenous catheterization and drug administration. This topic focuses on the diagnosis and management of lower-extremity SVT.

History and exam

Key diagnostic 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/edema 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 and Buerger disease)
recent vein instrumentation (e.g., sclerotherapy)
recent vein catheterization and intravenous drug administration
low-grade fever
pigmentation changes

Full details

Risk factors

varicose veins
thrombophilic disorders
autoimmune diseases (e.g., Behcet and Buerger disease)
prior history of superficial vein thrombosis (SVT)
female sex
sclerotherapy
intravenous catheterization
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 immobilization (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

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

nonpregnant: 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

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

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

Disclosures

LA declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021 Dec;160(6):e545-608.Full text Abstract

Kakkos SK, Gohel M, Baekgaard N, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021 Jan;61(1):9-82.Full text Abstract

Thrombosis Canada. Superficial thrombophlebitis, superficial vein thrombosis. Aug 2023 [internet publication].Full text

Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2018 Feb 25;(2):CD004982.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Deep vein thrombosis
- Cellulitis
- Lymphedema
More Differentials
Guidelines
- Superficial thrombophlebitis, superficial vein thrombosis
- Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report
More Guidelines
Patient information
Deep vein thrombosis
Varicose veins
More Patient information
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Superficial vein thrombosis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

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

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

nonpregnant: 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

incompetent saphenous vein with associated varicose veins or recurrent SVT

Contributors

Authors

Sherry Scovell, MD, FACS

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Francois Becker, MD, PhD

Disclosures

Michael Bromberg, MD, PhD

Disclosures

Louis Aledort, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice