Thrombophlebitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: White Leg; phlebitis
Overview
Historical Perspective
- In 1913, Burnham AC discussed thrombophlebitis in postoperative patients.[1]
- Historically, the treatment of thrombophlebitis was purely surgical and consisted of removal of the thrombosed vein.[2]
Classification
Thrombophlebitis can be classified according to the cause into:[3]
Type of Thrombophlebitis | Description |
---|---|
Sterile | Most common type of thrombophlebitis |
Traumatic | Associated with the following conditions:
|
Infective | Mostly due to prolonged IV cannulation |
Migratory | Recurrent thrombophlebitis at various sites. Associated with an underlying malignancy, most commonly adenocarcinoma of the pancreas |
Thrombophlebitis may also be classified according to the site into:[4]
- Superficial thrombophlebitis of the lower limb: most common location and it involves the great and short saphenous veins
- Superficial thrombophlebitis of the arms
- Superficial thrombophlebitis of the breast: also known as Mondor's disease
- Superficial thrombophlebitis of the abdominal wall
Pathophysiology
Pathogenesis
Microscopic Pathology
Genetics
Associated Conditions
Thrombophlebitis may be associated with the following conditions:
- Coagulation abnormalities:[3][5]
- Thromboangiitis obliterans (Buerger's Disease)[6]
- Underlying malignancy, especially adenocarcinoma of the pancreas in the case of migratory thrombophlebitis[7][8]
Causes
Common Causes
- Deep vein thrombosis
- Drug side effects
- Intravenous infusion
- IV catheter infection
- Levamisole-induced vasculopathy
- Penicillin G potassium infusion
- Thromboangiitis obliterans
- Thrombophlebitis migrans
- Varicose veins
- Vein injury
Causes by Organ System
Causes in Alphabetical Order
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3Differentiating Thrombophlebitis from other Diseases
Epidemiology and Demographics
Epidemiology
Incidence
- The incidence of thrombophlebitis is estimated at 100 per 100,000 cases.[4][9]
- Thrombophlebitis is 6 times more common than DVT.[4]
Demographics
Age
- The incidence of thrombophlebitis is more common with increasing age.[4]
Risk Factors
The following are associated with an increased risk of thrombophlebitis:[3][10][11][4]
- Chronic venous disease, such as varicose veins (most common risk factor)[12][13] and chronic venous insufficiency
- Venous thrombosis, whether a prior history or current DVT[10]
- Venous stasis, associated with prolonged immobility and prolonged surgery
- Hypercoagulable states, such as malignancy[12], pregnancy and the use of estrogen-based hormone therapy[14]
- Trauma to the vessel, such as IV cannulation, sclerotherapy and surgical ablation
- Obesity
Natural History, Complications and Prognosis
Screening
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
- ↑ Burnham AC (1913). "II. Postoperative Thrombophlebitis". Ann. Surg. 57 (2): 151–62. PMC 1407408. PMID 17862964.
- ↑ Homans J (1928). "THROMBOPHLEBITIS OF THE LOWER EXTREMITIES". Ann. Surg. 87 (5): 641–51. PMC 1398549. PMID 17865873.
- ↑ 3.0 3.1 3.2 Nasr H, Scriven JM (2015). "Superficial thrombophlebitis (superficial venous thrombosis)". BMJ. 350: h2039. PMID 26099257.
- ↑ 4.0 4.1 4.2 4.3 4.4 Scott G, Mahdi AJ, Alikhan R (2015). "Superficial vein thrombosis: a current approach to management". Br. J. Haematol. 168 (5): 639–45. doi:10.1111/bjh.13255. PMID 25521017.
- ↑ Martinelli I, Cattaneo M, Taioli E, De Stefano V, Chiusolo P, Mannucci PM (1999). "Genetic risk factors for superficial vein thrombosis". Thromb. Haemost. 82 (4): 1215–7. PMID 10544900.
- ↑ Olin JW (2000). "Thromboangiitis obliterans (Buerger's disease)". N. Engl. J. Med. 343 (12): 864–9. doi:10.1056/NEJM200009213431207. PMID 10995867.
- ↑ Diaconu C, Mateescu D, Bălăceanu A, Marcu M, Jianu V, Stănică A (2010). "Pancreatic cancer presenting with paraneoplastic thrombophlebitis--case report". J Med Life. 3 (1): 96–9. PMC 3019029. PMID 20302205.
- ↑ Varki A (2007). "Trousseau's syndrome: multiple definitions and multiple mechanisms". Blood. 110 (6): 1723–9. doi:10.1182/blood-2006-10-053736. PMC 1976377. PMID 17496204.
- ↑ Di Nisio M, Wichers IM, Middeldorp S (2013). "Treatment for superficial thrombophlebitis of the leg". Cochrane Database Syst Rev (4): CD004982. doi:10.1002/14651858.CD004982.pub5. PMID 23633322.
- ↑ 10.0 10.1 Guex JJ (1996). "Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis". Dermatol Surg. 22 (4): 378–82. PMID 8624665.
- ↑ Samlaska CP, James WD (1990). "Superficial thrombophlebitis. II. Secondary hypercoagulable states". J. Am. Acad. Dermatol. 23 (1): 1–18. PMID 2195069.
- ↑ 12.0 12.1 Gillet JL, Allaert FA, Perrin M (2004). "[Superficial thrombophlebitis in non varicose veins of the lower limbs. A prospective analysis in 42 patients]". J Mal Vasc (in French). 29 (5): 263–72. PMID 15738838.
- ↑ De Maeseneer MG (2005). "Superficial thrombophlebitis of the lower limb: practical recommendations for diagnosis and treatment". Acta Chir. Belg. 105 (2): 145–7. PMID 15906904.
- ↑ McColl MD, Ramsay JE, Tait RC, Walker ID, McCall F, Conkie JA, Carty MJ, Greer IA (1997). "Risk factors for pregnancy associated venous thromboembolism". Thromb. Haemost. 78 (4): 1183–8. PMID 9364982.