Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- previous superficial vein thrombophlebitis (SVT), deep vein thrombosis (DVT), or pulmonary embolism (PE)
- 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
Other diagnostic factors
- varicose veins
- recent vein instrumentation (e.g., sclerotherapy)
- recent vein cannulation and intravenous drug administration
- low-grade fever
- pigmentation changes
Risk factors
- varicose veins
- thrombophilic disorders
- autoimmune diseases (e.g., Behcet's and Buerger's disease)
- prior history of SVT
- female sex
- sclerotherapy
- intravenous catheterisation
- malignancy
- pregnancy
- use of oral contraceptives and hormonal replacement therapy
- older age
- history of prior VTE, including DVT and PE
- obesity
- prolonged immobilisation (e.g., long-haul air travel)
Diagnostic investigations
Investigations to consider
- biopsy
- pulmonary CT angiography
- ventilation perfusion (VQ) scan
- conventional pulmonary angiography
- assessment for malignancy
- thrombophilia screening
Treatment algorithm
Contributors
Authors VIEW ALL
Associate Professor
Department of Medicine
McGill University
Montreal
Canada
Disclosures
VT has received reimbursement for consultancy work for Pzifer Canada, Sanofi Canada, Bayer, Bristol Myers Squibb, and Daiichi Sankyo. All of these companies are makers of anticoagulants. She has received an investigator-initiated grant from Sanofi Canada.
Professor Vicky Tagalakis would like to gratefully acknowledge Frédérique St-Pierre, a medical student who worked with her to update this topic. FSP declares that he has no competing interests.
Peer reviewers VIEW ALL
Consultant
Division of Angiology and Hemostasis
University Hospital of Geneva
Geneva
Switzerland
Disclosures
FB declares that he has no competing interests.
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.
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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