On a busy clinic day, a familiar woman limped in with a frown: “Hello Dr. Zhang, I am xxx who saw you last month, I had an appointment for surgery tomorrow, but this morning I suddenly found that my thighs are painful and swollen, and I have difficulty walking. We asked her to sit down, pulled up her pants and examined her, and it was obvious that the inner thighs had obvious redness and swelling at the location of the original varicose vein lesions. (The picture on the left is the first visit and the picture on the right is the second visit.) Dr. Zhang Qiang immediately performed a venous ultrasound for her personally, which clearly showed that a blood clot had formed in the superficial vein, but fortunately it had not spread to the deep vein causing a dangerous situation. After careful examination and exclusion of other conditions, it was clear that this was a classic case of acute thrombotic superficial phlebitis complicated by varicose veins in the lower extremities. We quickly helped this woman to arrange an emergency surgery, and three hours after the operation she was able to leave the hospital walking with a normal gait, and her pain and hidden problems were largely eliminated. We encounter 3-5 cases like this almost every month. Varicose veins in the lower extremities have a long course, often without symptoms for years or even decades, and many patients feel no pain or itch, so they take conservative treatment first. However, with the development of the disease, when superficial vein thrombosis, superficial phlebitis, bleeding, ulcers and other complications occur, it often brings great pain to patients and seriously affects their lives. Thrombotic superficial phlebitis is one of the most common varicose vein complications. We counted that among the nearly 1,000 varicose vein patients who came to Zhang Qiang’s vascular team for examination and treatment from 2013 to the present, the percentage of patients with combined thrombotic superficial phlebitis reached about 12%. How is superficial thrombophlebitis diagnosed? The most obvious symptoms of superficial thrombophlebitis are tenderness and erythema of the superficial venous distribution; swelling; elevated local extremity temperature and palpable streaks of hardness; the extent of the thrombus can spread up or down the vein; and the local inflammatory response usually lasts 1-2 weeks before subsiding, relieving pain, and darkening the skin. In rare cases, superficial vein thrombosis can cause deep vein thrombosis by spreading upward or through the traffic veins and into the deep veins. The diagnosis of thrombotic superficial phlebitis can be made by performing ultrasound of the veins of the lower extremities. Care should be taken to rule out the following conditions: If there is an elevated temperature, suspect an infection. Cellulitis or lymphangitis (dengue) of the leg may also present as redness, swelling, and pain in the lower leg, usually with high fever, chills, and elevated routine blood leukocytes to clarify the infection. Deep vein thrombosis also presents as swelling and pain in the lower extremities. It may coexist with superficial phlebitis. Squeezing the calf muscles with the hand may be felt as pain in the deeper areas, which may be clarified by venous ultrasound and D-dimer in the lower extremities. Most importantly, if a patient with varicose veins notices redness, swelling or pain in the lower extremities, it is important to contact your doctor or visit the hospital. Conservative or surgical treatment? It is necessary to weigh the pros and cons and choose the appropriate treatment plan according to different conditions. A generalized view is that superficial phlebitis is not suitable for surgery during an episode of phlebitis and is prone to non-healing incisions and advocates conservative treatment first. However, if the superficial vein thrombosis is large and is not expected to subside in a short period of time, and if there is a risk of spreading to the deep veins, the advantages of early surgery outweigh the disadvantages, provided that minimally invasive surgical techniques are available. Individualized treatment plans for different conditions need to be determined with the help of an experienced surgeon. When to operate? For larger superficial vein thrombosis, within two weeks of occurrence is the best time to operate. Early surgery can remove the thrombus while avoiding the risk of superficial vein thrombosis spreading to deep veins, and recovery is faster after surgery. Preoperative ultrasound is required to confirm the progression and extent of venous thrombosis. If the optimal time for surgery has been missed (thrombosis for more than a month), mechanization has often begun and surgical forcible removal of the thrombus may damage other tissues, so minimally invasive surgery is used to treat varicose veins and reduce the risk of repeated and repeated superficial phlebitis. Superficial phlebitis takes time to slowly subside. Conservative treatment Conservative treatment consists of oral aspirin and local heat application. Superficial thrombophlebitis is a sterile inflammatory condition and antibiotic therapy is often ineffective. (Except in cases of co-infection, which needs to be determined by a physician.) Superficial vein thrombosis after sclerotherapy Sclerotherapy injections require no anesthesia, no incisions, and are inexpensive, but they are problematic and carry significant risks. First, the sclerosing agent injection solution can be extravasated to skin necrosis. The second is that once the sclerosing agent flows into the deep veins, it can lead to deep vein thrombosis, and there is a risk of pulmonary embolism. Patients who come to the clinic with extensive superficial vein thrombosis caused by sclerotherapy often suffer from severe adhesions between the surrounding tissues and the skin due to the extravasation of chemicals. Prognosis When varicose veins in the lower extremities progress to the stage of complications such as thrombophlebitis, the effect of surgery is reduced, such as the failure to eliminate the darkening of the skin and the poor effect on edema. A few patients with longer duration of disease may have recurrent episodes of superficial phlebitis. Therefore, patients with varicose veins in the lower extremities should undergo minimally invasive varicose vein surgery before complications arise.