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
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
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
Diagnostic tests
1st tests to order
- Doppler ultrasonography
Tests to consider
- biopsy
- pulmonary CT angiography
- ventilation perfusion (VQ) scan
- conventional pulmonary angiography
- assessment for malignancy
- thrombophilia screening
Treatment algorithm
extension into the femoral vein or popliteal vein, thrombus ≤3 from the saphenofemoral or saphenopopliteal junction, or concomitant DVT or PE
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
incompetent saphenous vein with associated varicose veins or recurrent SVT
Contributors
Authors
Sherry Scovell, MD, FACS
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.
Acknowledgements
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
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.
Differentials
- Deep vein thrombosis
- Cellulitis
- Lymphedema
More DifferentialsGuidelines
- Superficial thrombophlebitis, superficial vein thrombosis
- Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report
More GuidelinesPatient information
Deep vein thrombosis
Varicose veins
More Patient information
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