Thrombophlebitis
"Thrombo" means "clot." Phlebitis is inflammation of a vein. Thrombophlebitis (throm-bo-fluh-BI-tis) occurs when a blood clot causes inflammation in one or more of your veins, typically in your legs. On rare occasions, thrombophlebitis (often shortened to "phlebitis") can affect veins in your arms or neck.
The affected vein may be near the surface of your skin, causing superficial thrombophlebitis, or deep within a muscle, causing deep vein thrombosis (DVT). A clot in a deep vein increases your risk of serious health problems, including a dislodged clot (embolism) traveling to your lungs and blocking a pulmonary artery (pulmonary embolism).
Thrombophlebitis often is caused by prolonged inactivity, such as from sitting during a long period of travel in an airplane or automobile or from lengthy bed rest after surgery. Such inactivity decreases blood flow through your veins and may cause a clot to form. Paralysis, certain types of cancer and use of the hormone estrogen also may lead to thrombophlebitis. An inherited tendency for blood clots places you at higher risk of thrombophlebitis.
You can use self-care methods to ease pain and reduce your risk of clots. Various treatments, including medications and surgery, also are available for thrombophlebitis.
Signs and Symptoms
Signs and symptoms of thrombophlebitis include:
- Warmth, tenderness and pain in the affected area
- Redness and swelling
When a superficial vein is affected, a red, hard and tender cord may be present just under the surface of your skin. When a deep vein in the leg is affected, your leg may become swollen, tender and painful, most noticeably when you stand or walk. You may also have a fever. However, many people with deep vein thrombosis have no symptoms.
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Risk Factors
The cause of thrombophlebitis is a blood clot. Blood clots can result from many different things - namely anything that causes your blood not to circulate properly. Your risk of thrombophlebitis increases if you:
- Are inactive for a long period of time, such as from sitting in a car or an airplane
- Are confined to bed for a prolonged time, such as after surgery, a heart attack or a leg fracture
- Have a type of cancer, such as pancreatic cancer, that may cause an increase of procoagulants - substances necessary for blood clotting (coagulation) - in your blood
- Have had a stroke that resulted in paralysis of your arms or legs
- Have a pacemaker or have a thin, flexible tube (catheter) in a central vein, for treatment of a medical condition, which may irritate the blood vessel wall and decrease blood flow
- Are pregnant or have just given birth, which may mean you have increased pressure in the veins of your pelvis and legs
- Use oral contraceptives or hormone replacement therapy, which may increase the clotting factors in your blood
- Have a family history of a blood-clotting disorder or a tendency of blood clots
- Are overweight or obese
- Have varicose veins - clots may develop in dilated superficial veins (varicose veins), causing superficial thrombophlebitis
- Are a smoker
The more risk factors you have, the higher your risk of thrombophlebitis. If you have one or more risk factors, be sure to discuss prevention strategies with your doctor before long periods of inactivity, such as a long flight, a long car ride or after an elective surgery.
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Screening and Diagnosis
To diagnose thrombophlebitis, your doctor will ask you about the discomfort you've experienced and then examine any affected veins near the surface of your skin. To determine whether you have superficial or deep vein thrombosis, your doctor may choose one of these methods:
- Ultrasound. A wand-like device (transducer) placed over your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect back, a computer transforms the waves into a moving image on a video screen. A clot may be visible in the image.
- CT or MRI scans. Both computerized tomography (CT) and magnetic resonance imaging (MRI) can provide visual images of your veins and may show if a clot is present. Sometimes a venous thrombosis is found when these scans are performed for other reasons.
- Venography. A dye (contrast agent) is injected into a large vein in your foot or ankle. An X-ray procedure creates an image of the veins in your legs and feet, to look for clots. This test is used less frequently today because less invasive studies can usually confirm the diagnosis.
- Blood test. Almost all people who develop acute thrombosis have an elevated blood level of a clot-dissolving substance called D dimer. However, D dimer is elevated in other conditions, too. Thus, although a test for D dimer is very sensitive, it's not very conclusive. Currently, it's most useful for ruling out deep vein thrombosis or for identifying people at risk of recurrence.
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Treatment
If thrombophlebitis occurs in a superficial vein, your doctor may recommend self-care steps that include applying heat to the painful area, elevating the affected leg and using a nonsteroidal anti-inflammatory drug. The condition usually subsides within a week or two.
Your doctor may also recommend these treatments for thrombophlebitis:
- Medications. If you have deep vein thrombosis, injection of a blood-thinning (anticoagulant) medication, such as heparin, will prevent clots from growing. After the heparin treatment, taking the anticoagulant warfarin (Coumadin) for several months continues to prevent clots from growing. Sometimes, you may need a drug to dissolve the clot.
- Support stockings. These help prevent recurrent swelling and reduce the chances of complications of deep vein thrombosis. Your doctor may recommend prescription-strength support hose.
- Filter. In some instances, especially if you can't take blood thinners due to a bleeding condition, a filter may be inserted into the main vein in your abdomen (vena cava) to prevent clots that break loose in leg veins from lodging in your lungs.
- Varicose vein stripping. Your doctor can surgically remove varicose veins that cause pain or recurrent thrombophlebitis in a procedure called varicose vein stripping. This procedure, typically done on an outpatient basis, involves removing a long vein through small incisions. Usually, you're able to resume normal activities in two weeks or less. Removing the vein won't affect circulation in your leg because veins deeper in the leg take care of the increased volumes of blood. This procedure is also commonly done for cosmetic reasons.
- Clot removal or bypass. Sometimes, surgery is necessary to remove an acute clot blocking a pelvic vein or an abdominal vein. To treat a blocked vein that is chronic and disabling, your doctor may recommend surgery to bypass the vein, or a nonsurgical procedure called angioplasty to open up the vein. Once angioplasty has opened up the vein, your doctor inserts a small wire mesh tube (stent) to keep the vein open.
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Prevention
Quit smoking if you're a smoker because smoking increases your risk of a blood clot.
Sitting during a long flight or car ride can cause swollen ankles and calves. The inactivity also increases your risk of thrombophlebitis in the veins of your legs. To help prevent a blood clot from forming:
- Take a walk. If you're flying, walk around the airplane cabin once an hour or so. If you're driving, stop every hour and walk around the car a couple of times.
- If you must stay seated, move your legs regularly. Flex your ankles, or press your feet against the seat in front of you at least 10 times each hour.
On flights or car rides lasting more than four hours, take additional precautions to reduce your risk of deep vein thrombosis. These include:
- Avoid wearing tight clothing around your waist.
- Drink plenty of fluids to avoid dehydration.
- Stretch your calves by walking at least once an hour.
If you're at increased risk of deep vein thrombosis, talk to your doctor before your flight. He or she may recommend:
- Compression stockings
- Low-molecular heparin given before departure
Aspirin therapy is generally not recommended, and could thin your blood excessively if you're also taking warfarin (Coumadin). However, if you are on aspirin for other reasons, such as a heart attack, you should continue taking it.