Superficial vein thrombophlebitis

Last reviewed: April 2018

Last updated: April 2018

Summary

Superficial vein thrombophlebitis (SVT) of the lower limb is most often a complication of varicose veins.

Duplex ultrasonography should be performed on 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 to prevent venous thromboembolic complications (DVT or pulmonary embolism) is warranted, especially in patients with SVT near the saphenofemoral junction, or when the superficial thrombus is 5 cm or greater in length.

Definition

Superficial vein thrombophlebitis (SVT) refers to thrombus formation in a superficial vein, and inflammation in the tissue surrounding the vein. It is generally characterised 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 and its tributaries of the lower limbs. It can also occur in the veins of the upper limbs or neck, usually due to intravenous cannulation and drug administration. The term SVT is generally reserved for the specific problem of SVT in the lower limbs. This monograph will concentrate on lower-limb SVT.

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

Full details

Other diagnostic factors

varicose veins
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 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)

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, <2 cm from the saphenofemoral junction, or concomitant DVT or PE

ACUTE

SVT: ≥5 cm in length and/or within 3-5 cm of the saphenofemoral junction

SVT: <5 cm in length on localised venous ectasia (varicophlebitis), not within 3-5 cm of the saphenofemoral junction, no risk factors for VTE

SVT: <5 cm in length on localised venous ectasia (varicophlebitis), not within 3-5 cm of the saphenofemoral junction, at least one risk factor for VTE

ONGOING

recurrent superficial vein thrombophlebitis (SVT) with extensive varicose veins

Contributors

Authors VIEW ALL 

Vicky Tagalakis, MD, FRCPC, MSC

Associate Professor

Department of Medicine

McGill University

Montreal

Canada

Disclosures

VT has received reimbursement for consultancy work for Pzifer Canada, Sanofi Canada, Bayer, Bristol Myer Squib, and Leo Pharma. She has received an investigator-initiated grant from Sanofi Canada.

Acknowledgements,

Professor Vicky Tagalakis would like to gratefully acknowledge Frédérique St-Pierre, a medical student who worked with her to update this topic.

Disclosures

FSP declares that he has no competing interests.

Peer reviewers VIEW ALL 

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.

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Superficial vein thrombophlebitis

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, <2 cm from the saphenofemoral junction, or concomitant DVT or PE

SVT: ≥5 cm in length and/or within 3-5 cm of the saphenofemoral junction

SVT: <5 cm in length on localised venous ectasia (varicophlebitis), not within 3-5 cm of the saphenofemoral junction, no risk factors for VTE

SVT: <5 cm in length on localised venous ectasia (varicophlebitis), not within 3-5 cm of the saphenofemoral junction, at least one risk factor for VTE

recurrent superficial vein thrombophlebitis (SVT) with extensive varicose veins

Contributors

Authors VIEW ALL 

Vicky Tagalakis, MD, FRCPC, MSC

Disclosures

Acknowledgements,

Disclosures

Peer reviewers VIEW ALL 

Francois Becker, MD, PhD

Disclosures

Michael Bromberg, MD, PhD

Disclosures

Louis Aledort, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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