Last reviewed: 24 Jun 2021
Last updated: 23 Mar 2021

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
  • history of thrombophilic disorders
  • 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

Vicky Tagalakis, MD, FRCPC, MSc
Vicky Tagalakis

Associate Professor

Department of Medicine

McGill University

Montreal

Canada

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.

Acknowledgements

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

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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