Last reviewed: September 2018
Last updated: May  2018

Summary

Definition

History and exam

Key diagnostic 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/edema 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
  • hx of thrombophilic disorders
  • autoimmune diseases (e.g., Behcet and Buerger disease)
  • 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 and Buerger disease)
  • prior history of SVT
  • female sex
  • sclerotherapy
  • intravenous catheterization
  • malignancy
  • pregnancy
  • use of oral contraceptives and hormonal replacement therapy
  • older age
  • history of prior VTE, including DVT and PE
  • obesity
  • prolonged immobilization (e.g., long-haul air travel)

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

Contributors

Authors VIEW ALL

Vicky Tagalakis

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.

Disclosures

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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