Thrombophlebitis: Difference between revisions

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*[[Obesity]]
*[[Obesity]]


==[[Thrombophlebitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==Natural History, Complications and Prognosis==
 
===Natural History===
Thrombophlebitis was thought of as a benign condition. However, if left untreated, thrombophlebitis can recur or extend to involve the deep venous system. [[DVT]] can still complicate 10% of cases, despite treatment.<ref name="pmid24549553">{{cite journal |vauthors=Di Nisio M, Middeldorp S |title=Treatment of lower extremity superficial thrombophlebitis |journal=JAMA |volume=311 |issue=7 |pages=729–30 |year=2014 |pmid=24549553 |doi=10.1001/jama.2014.520 |url=}}</ref>
 
===Complications===
Complications of thrombophlebitis include:<ref name="pmid26099257">{{cite journal |vauthors=Nasr H, Scriven JM |title=Superficial thrombophlebitis (superficial venous thrombosis) |journal=BMJ |volume=350 |issue= |pages=h2039 |year=2015 |pmid=26099257 |doi= |url=}}</ref><ref name="pmid1866693">{{cite journal |vauthors=Lutter KS, Kerr TM, Roedersheimer LR, Lohr JM, Sampson MG, Cranley JJ |title=Superficial thrombophlebitis diagnosed by duplex scanning |journal=Surgery |volume=110 |issue=1 |pages=42–6 |year=1991 |pmid=1866693 |doi= |url=}}</ref><ref name="pmid8918318">{{cite journal |vauthors=Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ |title=Progression of superficial venous thrombosis to deep vein thrombosis |journal=J. Vasc. Surg. |volume=24 |issue=5 |pages=745–9 |year=1996 |pmid=8918318 |doi= |url=}}</ref><ref name="pmid3081214">{{cite journal |vauthors=Bergqvist D, Jaroszewski H |title=Deep vein thrombosis in patients with superficial thrombophlebitis of the leg |journal=Br Med J (Clin Res Ed) |volume=292 |issue=6521 |pages=658–9 |year=1986 |pmid=3081214 |pmc=1339644 |doi= |url=}}</ref><ref name="pmid28116936">{{cite journal |vauthors=Sándor T |title=[Superficial venous thrombosis. A state of art] |language=Hungarian |journal=Orv Hetil |volume=158 |issue=4 |pages=129–138 |year=2017 |pmid=28116936 |doi=10.1556/650.2017.30618 |url=}}</ref>
*[[Venous thromboembolism]] and subsequent [[pulmonary embolism]]: this is especially common when superficial thrombophlebitis occurs at the junction with the deep venous system<ref name="pmid9510288">{{cite journal |vauthors=Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J |title=Occult deep venous thrombosis complicating superficial thrombophlebitis |journal=J. Vasc. Surg. |volume=27 |issue=2 |pages=338–43 |year=1998 |pmid=9510288 |doi= |url=}}</ref><ref name="pmid9576081">{{cite journal |vauthors=Hanson JN, Ascher E, DePippo P, Lorensen E, Scheinman M, Yorkovich W, Hingorani A |title=Saphenous vein thrombophlebitis (SVT): a deceptively benign disease |journal=J. Vasc. Surg. |volume=27 |issue=4 |pages=677–80 |year=1998 |pmid=9576081 |doi= |url=}}</ref><ref name="pmid10587397">{{cite journal |vauthors=Verlato F, Zucchetta P, Prandoni P, Camporese G, Marzola MC, Salmistraro G, Bui F, Martini R, Rosso F, Andreozzi GM |title=An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh |journal=J. Vasc. Surg. |volume=30 |issue=6 |pages=1113–5 |year=1999 |pmid=10587397 |doi= |url=}}</ref><ref name="pmid20860504">{{cite journal |vauthors=Decousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G, Leizorovicz A |title=Fondaparinux for the treatment of superficial-vein thrombosis in the legs |journal=N. Engl. J. Med. |volume=363 |issue=13 |pages=1222–32 |year=2010 |pmid=20860504 |doi=10.1056/NEJMoa0912072 |url=}}</ref><ref name="pmid2098372">{{cite journal |vauthors=Belcaro G |title=Evolution of superficial vein thrombosis treated with defibrotide: comparison with low dose subcutaneous heparin |journal=Int J Tissue React |volume=12 |issue=5 |pages=319–24 |year=1990 |pmid=2098372 |doi= |url=}}</ref><ref name="pmid10431991">{{cite journal |vauthors=Belcaro G, Nicolaides AN, Errichi BM, Cesarone MR, De Sanctis MT, Incandela L, Venniker R |title=Superficial thrombophlebitis of the legs: a randomized, controlled, follow-up study |journal=Angiology |volume=50 |issue=7 |pages=523–9 |year=1999 |pmid=10431991 |doi= |url=}}</ref>
*[[Hyperpigmentation]] of the [[skin]] overlying the affected [[vein]]
*[[Infection]] and [[abscess]] formation
 
===Prognosis===


==[[Thrombophlebitis screening|Screening]]==
==[[Thrombophlebitis screening|Screening]]==

Revision as of 21:31, 16 February 2017

Template:Thrombophlebitis For patient information, click here

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]

  1. Superficial thrombophlebitis of the lower limb: most common location and it involves the great and short saphenous veins
  2. Superficial thrombophlebitis of the arms
  3. Superficial thrombophlebitis of the breast: also known as Mondor's disease
  4. Superficial thrombophlebitis of the abdominal wall

Pathophysiology

Pathogenesis

Microscopic Pathology

Genetics

Associated Conditions

Thrombophlebitis may be associated with the following conditions:

Causes

Common Causes

Causes by Organ System

Cardiovascular Deep veinous thrombosis, Levamisole-induced vasculopathy, Polyarteritis nodosa , Thromboangiitis obliterans, Thrombophlebitis migrans, Varicose veins, Vein injury
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Aprotinin, Caspofungin acetate, Cefepime, Cefoxitin sodium, Ceftazidime, Cidofovir, Clomifene, Desogestrel and ethinyl estradiol, Doripenem, Doxorubicin hydrochloride, Epirubicin, Ergonovine, Estramustine, Estropipate, Ethanolamine oleate, Ganciclovir, Hemin, Imipenem-cilastatin, Indomethacin, Letrozole, Levamisole-induced vasculopathy, Megestrol, Melarsoprol, Meropenem, Methocarbamol, Mitomycin, Naltrexone, Penicillamine, Penicillin g potassium, Pergolide, Piperacillin, Pramipexole, Prednisolone, Quinupristin-dalfopristin, Tiagabine, Toremifene, Tromethamine, Valganciclovir, Zonisamide
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Inflammatory bowel disease, Pancreatic carcinoma, Parenteral nutrition
Genetic Genetics
Hematologic Blood transfusion , Intravenous infusion, Iv catheter infection, Penicillin g potassium, Prolonged sitting , Pulmonary embolism, Superficial thrombophlebitis, Thromboangiitis obliterans, Thrombophlebitis migrans
Iatrogenic Blood transfusion , Estrogen therapy, Intravenous infusion, Iv catheter infection
Infectious Disease Hiv
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Parenteral nutrition
Obstetric/Gynecologic No underlying causes
Oncologic Pancreatic carcinoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Pulmonary embolism
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Behçet's disease, Lupus
Sexual Hiv
Trauma Prolonged sitting , Vein injury
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}.
3

Differentiating 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]

Natural History, Complications and Prognosis

Natural History

Thrombophlebitis was thought of as a benign condition. However, if left untreated, thrombophlebitis can recur or extend to involve the deep venous system. DVT can still complicate 10% of cases, despite treatment.[15]

Complications

Complications of thrombophlebitis include:[3][16][17][18][19]

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

Case #1


Template:WikiDoc Sources

  1. ↑ Burnham AC (1913). "II. Postoperative Thrombophlebitis". Ann. Surg. 57 (2): 151–62. PMC 1407408. PMID 17862964.
  2. ↑ Homans J (1928). "THROMBOPHLEBITIS OF THE LOWER EXTREMITIES". Ann. Surg. 87 (5): 641–51. PMC 1398549. PMID 17865873.
  3. ↑ 3.0 3.1 3.2 3.3 Nasr H, Scriven JM (2015). "Superficial thrombophlebitis (superficial venous thrombosis)". BMJ. 350: h2039. PMID 26099257.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Olin JW (2000). "Thromboangiitis obliterans (Buerger's disease)". N. Engl. J. Med. 343 (12): 864–9. doi:10.1056/NEJM200009213431207. PMID 10995867.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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. ↑ 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.
  11. ↑ Samlaska CP, James WD (1990). "Superficial thrombophlebitis. II. Secondary hypercoagulable states". J. Am. Acad. Dermatol. 23 (1): 1–18. PMID 2195069.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ Di Nisio M, Middeldorp S (2014). "Treatment of lower extremity superficial thrombophlebitis". JAMA. 311 (7): 729–30. doi:10.1001/jama.2014.520. PMID 24549553.
  16. ↑ Lutter KS, Kerr TM, Roedersheimer LR, Lohr JM, Sampson MG, Cranley JJ (1991). "Superficial thrombophlebitis diagnosed by duplex scanning". Surgery. 110 (1): 42–6. PMID 1866693.
  17. ↑ Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ (1996). "Progression of superficial venous thrombosis to deep vein thrombosis". J. Vasc. Surg. 24 (5): 745–9. PMID 8918318.
  18. ↑ Bergqvist D, Jaroszewski H (1986). "Deep vein thrombosis in patients with superficial thrombophlebitis of the leg". Br Med J (Clin Res Ed). 292 (6521): 658–9. PMC 1339644. PMID 3081214.
  19. ↑ Sándor T (2017). "[Superficial venous thrombosis. A state of art]". Orv Hetil (in Hungarian). 158 (4): 129–138. doi:10.1556/650.2017.30618. PMID 28116936.
  20. ↑ Blumenberg RM, Barton E, Gelfand ML, Skudder P, Brennan J (1998). "Occult deep venous thrombosis complicating superficial thrombophlebitis". J. Vasc. Surg. 27 (2): 338–43. PMID 9510288.
  21. ↑ Hanson JN, Ascher E, DePippo P, Lorensen E, Scheinman M, Yorkovich W, Hingorani A (1998). "Saphenous vein thrombophlebitis (SVT): a deceptively benign disease". J. Vasc. Surg. 27 (4): 677–80. PMID 9576081.
  22. ↑ Verlato F, Zucchetta P, Prandoni P, Camporese G, Marzola MC, Salmistraro G, Bui F, Martini R, Rosso F, Andreozzi GM (1999). "An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh". J. Vasc. Surg. 30 (6): 1113–5. PMID 10587397.
  23. ↑ Decousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G, Leizorovicz A (2010). "Fondaparinux for the treatment of superficial-vein thrombosis in the legs". N. Engl. J. Med. 363 (13): 1222–32. doi:10.1056/NEJMoa0912072. PMID 20860504.
  24. ↑ Belcaro G (1990). "Evolution of superficial vein thrombosis treated with defibrotide: comparison with low dose subcutaneous heparin". Int J Tissue React. 12 (5): 319–24. PMID 2098372.
  25. ↑ Belcaro G, Nicolaides AN, Errichi BM, Cesarone MR, De Sanctis MT, Incandela L, Venniker R (1999). "Superficial thrombophlebitis of the legs: a randomized, controlled, follow-up study". Angiology. 50 (7): 523–9. PMID 10431991.
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