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
- history 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
Investigations 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, <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 localized venous ectasia (varicophlebitis), not within 3-5 cm of the saphenofemoral junction, no risk factors for VTE
SVT: <5 cm in length on localized venous ectasia (varicophlebitis), not within 3-5 cm of the saphenofemoral junction, at least one risk factor for VTE
recurrent SVT with extensive varicose veins
Contributors
Authors
Vicky Tagalakis, MD, FRCPC, MSc

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.
Differentials
- Deep vein thrombosis
- Cellulitis
- Lymphedema
More DifferentialsGuidelines
- Superficial thrombophlebitis, superficial vein thrombosis
- Guidelines for management of superficial vein thrombosis
More GuidelinesPatient leaflets
Deep vein thrombosis
Varicose veins
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