Superficial vein thrombophlebitis (SVT, also known as superficial vein thrombosis) of the lower limb is most often a complication of varicose veins.
Doppler (duplex) ultrasonography is recommended for all patients with suspected SVT of the lower limb, as concomitant deep vein thrombosis (DVT) may be present.
Underlying prothrombotic conditions should be sought in cases of recurrent SVT and migratory SVT, especially in the absence of varicose veins.
Anticoagulation to prevent venous thromboembolic complications (DVT or pulmonary embolism) is warranted, especially in patients with SVT near the saphenofemoral junction, or when the superficial thrombus is 5 cm or greater in length.
Superficial vein thrombophlebitis (SVT, also known as superficial venous thrombosis) refers to thrombus formation in a superficial vein, and inflammation in the tissue surrounding the vein. It is generally characterized by pain, tenderness, induration, and/or erythema in a superficial vein. There is often a palpable, sometimes nodular, cord with warmth and erythema, which suggests the presence of thrombus. It most often occurs in the saphenous vein of the lower limbs, and its tributaries. It can also occur in the veins of the upper limbs or neck, usually due to intravenous cannulation and drug administration. The term SVT is generally reserved for the specific problem of SVT in the lower limbs. This topic will concentrate on lower-limb SVT.
History and exam
- 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
- varicose veins
- thrombophilic disorders
- autoimmune diseases (e.g., Behcet and Buerger disease)
- prior history of SVT
- female sex
- intravenous catheterization
- use of oral contraceptives and hormonal replacement therapy
- older age
- history of prior VTE, including DVT and PE
- prolonged immobilization (e.g., long-haul air travel)
Vicky Tagalakis, MD, FRCPC, MSc
Department of Medicine
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.
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.
Francois Becker, MD, PhD
Division of Angiology and Hemostasis
University Hospital of Geneva
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
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
LA declares that he has no competing interests.
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