Thrombophlebitis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | |||
===Physical Examination=== | |||
===Laboratory Findings=== | |||
===Ultrasound=== | |||
===Other Imaging Findings=== | |||
===Other Diagnostic Studies=== | |||
==Treatment== | ==Treatment== |
Revision as of 21:33, 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]
- 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
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]
- 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
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]
- Venous thromboembolism and subsequent pulmonary embolism: this is especially common when superficial thrombophlebitis occurs at the junction with the deep venous system[20][21][22][23][24][25]
- Hyperpigmentation of the skin overlying the affected vein
- Infection and abscess formation
Prognosis
Screening
There are no screening recommendations for thrombophlebitis.[26]
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 3.3 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=thrombophlebitis. Accessed on Feb. 15, 2017