Thrombotic superficial phlebitis is a common disease in vascular surgery, which is receiving more and more attention as medical research becomes more advanced.
What are the symptoms of superficial thrombophlebitis?
The symptoms of thrombotic superficial phlebitis are obvious: erythema and tenderness in the superficial venous distribution area, as well as palpable streaks of thrombus, with significant pain and high skin temperature, and possible swelling. The symptoms are often recurrent.
A general Doppler ultrasound examination can clarify the condition and determine the extent of superficial venous thrombosis.
Why does superficial vein thrombosis occur?
There are many factors that predispose to superficial thrombophlebitis, usually grouped into the Virchow triad: venous endothelial injury, slow blood flow, and hypercoagulability.
Several factors usually act together to trigger a venous thrombosis.
(i) Intravenous injury
Superficial venous endothelial damage that can be caused by intravenous tubes, irritating drugs, infection, and trauma, which can lead to thrombotic superficial phlebitis.
(ii) Slow blood flow
varicose veins in the lower extremities, blood stagnation under conditions such as braking (e.g., bed rest after orthopedic surgery), etc., can predispose to venous thrombosis.
(iii) Conditions that can cause a hypercoagulable state of blood, including
1.After major surgery or major trauma
2, congenital abnormalities of coagulation substances, such as antithrombin III, protein c and protein s abnormalities
3.Pregnancy and oral contraceptives
4, hormone therapy
5.Malignant tumor
6.Patients with autoimmune disease
Third, the different types of thrombophlebitis and treatment methods
(A) varicose veins combined with thrombotic superficial phlebitis
Varicose veins are the most common factor of thrombotic superficial phlebitis, which often occurs in the cavity of the varicose superficial veins of the lower limbs. The manifestation is a painful hard node at the site of varicose veins, often surrounded by erythema. The thrombus can spread up or down the saphenous vein or occur in non-trunked varicose vein bifurcations. Except for some secondary to injury, a significant proportion often has no causative agent.
Treatment.
1, Superficial phlebitis is a sterile inflammation and usually does not require antibiotics; if combined with skin ulceration or infection, some anti-infective drugs may be used.
2, more extensive thrombophlebitis if there is a serious degree of pain, redness and widespread spread, bed rest, elevation of the affected limbs, physical therapy and hot compresses, local use of Xylitol. When you get out of bed, you should wear medical elastic stockings.
3.Superficial vein thrombosis caused by varicose veins tends to recur and may have the risk of spreading to deep veins and causing deep vein thrombosis, so surgery for varicose veins and superficial vein thrombosis removal is the best method.
(B) Post-traumatic thrombotic superficial phlebitis
Post-traumatic thrombotic superficial phlebitis usually occurs in patients who are hospitalized or treated with medications on an outpatient basis. It is often associated with intravenous catheters and irritating injectables, especially those left in place for long periods of time. It usually begins as pain, tenderness, and erythema at the puncture site or infusion area.
Treatment.
Stop the infusion, remove the tube, and apply local heat. Symptoms usually last for several days or weeks, sometimes months, before complete resolution.
(iii) Bacterial and septic superficial thrombophlebitis
Septic thrombophlebitis is usually associated with intravenous cannulation and is even fatal if bacteremia occurs. It usually presents as an abscess at the venipuncture site, severe pain, with fever and elevated white blood cells.
Treatment.
The catheter is removed, a bacterial culture is performed, and appropriate antibiotics are applied intravenously. In rare cases, incision is required to remove the infection.
(iv) Wandering superficial thrombophlebitis
It presents as recurrent superficial venous thrombosis occurring repeatedly in different locations, most commonly in the lower extremities.
This disease may be associated with malignancy or may be associated with some vasculitis, such as leukoaraiosis, thrombo-occlusive vasculitis and polyarteritis nodosa.
Treatment.
Treat symptomatically while searching for the cause. Abnormalities of antithrombin III, protein s or protein c should be noted.
(E) Thrombotic superficial phlebitis of the chest wall
Thrombotic superficial phlebitis of the chest wall, also known as Mondor disease, refers to thrombosis of superficial veins in the anterior chest wall, breast, rib cage, and upper abdomen with secondary inflammatory changes. It is characterized by localized thrombosis with tenderness and striated structures that are more pronounced when the skin is stretched or the upper extremity is elevated. The cause of the disease is not yet understood, except for the sudden strain on the upper limb and the damage suffered by the strained vein, which constitutes a factor in the pathogenesis of the disease, it may also be related to hypercoagulable state or breast cancer.
Treatment.
Conservative treatment is the mainstay, including hot compresses and the use of nonsteroidal anti-inflammatory drugs. Also look for the cause of the disease.