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Superficial vein thrombosis

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

Summary

Definition

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 tests

1st tests to order

  • Doppler ultrasonography
Full details

Tests 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

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.

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

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.

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.
  • Superficial vein thrombosis images
  • 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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