Thrombophlebitis: Superficial vs Migratory, Symptoms, Causes & Treatment Thrombophlebitis Form
May 15, Author: See Etiology and Workup. Although Thrombophlebitis Form thrombophlebitis usually occurs in the lower extremities, it also has been Thrombophlebitis Form in the penis and the breast Mondor disease.
Superficial thrombophlebitis can also develop anywhere that medical interventions occur, such as in the arm or neck external jugular vein when intravenous IV catheters are used. See Etiology, Presentation, and Workup. Thrombosis and thrombophlebitis of the superficial venous system receive little attention in medical and surgical textbooks, Thrombophlebitis Form. However, thrombophlebitis is encountered frequently and, although it is usually a benign, self-limiting disease, it can be recurrent and tenaciously persistent, at times causing significant incapacitation.
See Epidemiology and Prognosis. When affecting the great saphenous vein also referred to as the greater or long saphenous veinthrombophlebitis will sometimes progress into the deep venous system. Damage to deep venous valves leads to chronic deep venous insufficiency often referred to as postphlebitic syndromeThrombophlebitis Form, as well as to recurrent pulmonary embolism PE and an increased risk of death.
Superficial thrombophlebitis can occur spontaneously, especially in the lower extremities in the great saphenous vein, or as a complication of medical or surgical interventions. Although the etiology is frequently obscure, superficial venous thrombosis is most often associated with one of the components of the Virchow triad; ie, intimal damage which can result from trauma, Thrombophlebitis Form, infection, or inflammationstasis or turbulent flow, or changes in blood constituents presumably causing increased coagulability.
In each type of superficial thrombophlebitis, the condition Fraktion 2 ASD Anwendung Varizen as redness and tenderness along the course Thrombophlebitis Form the vein, usually accompanied by swelling.
Bleeding also can occur at the site of a varicose vein. Although unusual, superficial thrombophlebitis may occur in the lesser saphenous vein, which empties into the popliteal vein. Superficial thrombophlebitis can also occur in the external jugular vein, if it has been used for an infusion site, Thrombophlebitis Form.
Superficial thrombophlebitis of the upper extremities usually occurs at infusion sites or sites of trauma. Superficial thrombophlebitis is a clinical diagnosis in which the clinician identifies tender and inflamed superficial veins, Thrombophlebitis Form. However, ruling out DVT in the Thrombophlebitis Form setting is difficult; further testing is often required to evaluate for this condition. Thrombophlebitis Form Presentation and Workup.
Treatment for superficial thrombophlebitis is aimed at patient comfort and at preventing superficial phlebitis from involving Thrombophlebitis Form deep veins.
See Treatment and Medication. Superficial phlebitis with infection, such as phlebitis originating at an IV catheter site, Thrombophlebitis Form, is referred to as septic thrombophlebitisa clinical entity requiring diagnostic and therapeutic approaches that are different from those applied to sterile phlebitis. Microscopic thrombosis is a normal part of the dynamic balance of hemostasis.
Inthe German pathologist Virchow recognized that if this dynamic balance were altered by venous stasis or turbulence, abnormal coagulability, or vessel wall injuries, Thrombophlebitis Form, then microthrombi could propagate to form macroscopic thrombi.
In the absence of a triggering event, neither venous stasis nor abnormal coagulability alone causes clinically important thrombosis, but vascular endothelial injury does reliably result in thrombus formation, Thrombophlebitis Form.
The initiating injury triggers an inflammatory response that results in immediate platelet adhesion at the injury site. Further platelet aggregation is mediated by thromboxane A2 TxA2 and by thrombin. A more detailed visual of the coagulation pathway can be seen in the image below. Platelet aggregation due to TxA2 is inhibited irreversibly by aspirin and reversibly by other nonsteroidal anti-inflammatory drugs NSAIDs ; thrombin-mediated platelet aggregation, Thrombophlebitis Form, on the Thrombophlebitis Form hand, is not affected by NSAIDs, including aspirin.
This is why aspirin and other NSAIDs are somewhat effective in preventing arterial thrombosis, Thrombophlebitis Form, where platelet aggregation is mediated via TxA2, as seen in patients with stroke and myocardial infarction, Thrombophlebitis Form, but are not very effective in preventing venous thrombophlebitis, where it is believed that clot formation is more of a result Thrombophlebitis Form thrombin activation.
The most important clinically identifiable risk factors for thrombophlebitis are a prior history of superficial phlebitis, DVT, and PE. Some common risk markers include recent surgery or pregnancy, prolonged immobilization, Thrombophlebitis Form, and underlying malignancy.
Phlebitis also occurs in diseases associated with vasculitis, such as polyarteritis nodosa periarteritis nodosa and Buerger disease thromboangiitis obliterans. The increased likelihood of developing thrombophlebitis occurs through most of pregnancy and for approximately 6 weeks after delivery.
This is partly due to increased platelet stickiness and partly due to reduced fibrinolytic activity. The association between pregnancy and thrombophlebitis is of particular concern to women who carry the factor V Leiden or prothrombin Ca gene, because they already have a predisposition to clotting, which Thrombophlebitis Form also be exacerbated by pregnancy.
High-dose estrogen therapy is another risk factor. Case-controlled and cohort studies Thrombophlebitis Form on clinical signs and symptoms of thrombosis suggest that by taking high-estrogen oral contraceptives, Thrombophlebitis Form, a woman may increase her risk of thrombosis by a factor of times, though the absolute risk remains low.
Newer low-dose oral contraceptives are associated with a much lower risk of thrombophlebitis, though the absolute risk has not been well quantified. Superficial venous thrombosis following an injury usually occurs in an extremity, manifesting as a tender cord along the course of a vein juxtaposing the area of trauma, Thrombophlebitis Form.
Ecchymosis may be present early in the disease, indicating extravasation of blood associated with injury to the vein; this may turn to brownish pigmentation over the vein as the inflammation resolves.
Thrombophlebitis frequently occurs at the site of an IV infusion and is the result of irritating drugs, hypertonic solutions, or the intraluminal catheter or cannula itself, Thrombophlebitis Form. This is Thrombophlebitis Form far the most common type of thrombophlebitis encountered. Usually, redness and pain signal its presence while the infusion is being given, but thrombosis may manifest as a small lump days or weeks after the infusion apparatus has been removed.
Thrombophlebitis Form may take months to completely resolve, Thrombophlebitis Form. The features of iatrogenic form of traumatic chemical phlebitis may be deliberately produced by sclerotherapy during the treatment of varicose veins. Superficial thrombophlebitis frequently occurs in varicose veins. It may extend up and down the saphenous vein or may remain confined to a cluster of tributary varicosities Thrombophlebitis Form from the main saphenous vein.
Although thrombophlebitis may follow trauma to a varix, it often occurs in varicose veins without an antecedent cause. Thrombophlebitis in a varicose vein develops as a tender, hard knot and is frequently surrounded by erythema. At times, bleeding may occur as the reaction extends through the vein wall. It frequently is observed in varicose veins surrounding venous stasis ulcers. Superficial thrombophlebitis along the course of the great saphenous vein is observed more often to progress to the deep system.
Infection-related thrombophlebitis is associated with several different conditions, Thrombophlebitis Form, including a serious complication of intravascular cannulation and can be suspected in patients who have persistent bacteremia in the setting of appropriate antibiotic therapy. It also frequently is associated with septicemia. InDeTakats suggested that dormant infection in varicose veins was Thrombophlebitis Form factor in the development of thrombophlebitis occurring following operations or after injection treatments, trauma, or exposure to radiation therapy.
Altemeier et al Thrombophlebitis Form that the presence trophische Ulcussymptome und Behandlungsmethoden L-forms and other atypical bacterial forms in the blood may play an important etiologic role in the disease and recommended administration of tetracycline.
Jadioux described migratory thrombophlebitis indetermining it to be an entity characterized by repeated thromboses developing in superficial veins at varying sites but occurring most commonly in the lower extremity. Although numerous etiologic factors have been proposed for this condition, none have been confirmed.
The association of carcinoma with migratory thrombophlebitis was first reported by Trousseau, in Sproul noted migratory thrombophlebitis to be especially prevalent with carcinoma of the tail of the pancreas, Thrombophlebitis Form. Mondor disease is a rare condition. Thrombophlebitis is usually located in the anterolateral aspect of the upper portion of the breast or in the region extending from the lower portion of the breast across the submammary fold toward the costal margin and the epigastrium.
A characteristic finding is a tender, Thrombophlebitis Form, cordlike structure that may be best demonstrated by tensing the skin via elevation of the arm.
The cause of Mondor disease is unknown, but a search for malignancy is indicated. Mondor disease is more likely to occur after breast surgery, with the use of oral contraceptives, and with protein C deficiency. Thrombophlebitis of the dorsal vein of the penis, generally caused by trauma or repetitive injury, is also referred to as Mondor disease.
In the author's experience, superficial thrombophlebitis most frequently occurs in the age group ranging from young adulthood to middle age. However, Markovic et al reported that a common risk factor is age older than 60 years, though fewer complications occur in this age group. As previously mentioned, pregnancy, puerperium, and high-dose estrogen therapy are recognized risk factors for phlebitis.
However, there are no intrinsic, sex-linked risks for the disease. The prognosis in Thrombophlebitis Form thrombophlebitis is usually good. Superficial phlebitis is rarely associated with PE, although it can occur, particularly if the process extends into a deep vein. However, individuals with superficial venous thrombosis do not seem to have a great tendency to develop DVT.
In contrast, patients with DVT are frequently found to have superficial venous thrombosis. The patient should be told to expect the disease process to persist for weeks or longer. If it occurs in the lower extremity in association with varicose veins, Thrombophlebitis Form, it has a high likelihood of Thrombophlebitis Form unless excision is performed.
Because thrombophlebitis tends to recur if the vein trophische Geschwüre Blut not been excised, instructing the patient in ways to prevent stasis in the vein is usually advisable.
The use of elastic stockings may be indicated, especially if the patient plans to stand in an upright position for long periods. Slight elevation of the foot of the bed, avoidance of long periods of standing in an upright position, and avoidance of prolonged inactivity is recommended. An unexpectedly high Thrombophlebitis Form of pulmonary embolism in patients with superficial thrombophlebitis of the thigh.
The veins in thromboangiitis obliterans: With particular reference to arteriovenous anastomosis as a cure for the condition. Pathology, Diagnosis and Treatment. University of Nagoya Press; Best Pract Res Clin Rheumatol. Vasculopathy related to cocaine adulterated with levamisole: A review of the literature. Oral contraceptives, hormone replacement therapy and thrombosis.
Skin necrosis and venous thrombosis from subcutaneous injection of charcoal lighter fluid naptha. Am J Emerg Med. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: Am J Med Sci.
Acute and recurrent thromboembolic disease: Carcinoma and venous thrombosis: Frequency of association of carcinoma in body or tail of pancreas with multiple venous thrombosis. Nazir SS, Khan M. Thrombosis of the dorsal vein of the penis Mondor's Disease:
What is phlebitis and thrombophlebitis? Phlebitis means inflammation of a vein. Thrombophlebitis refers to a blood clot causing the inflammation. Phlebitis can be superficial, Thrombophlebitis Form, in the skin, or deep, in the tissues beneath the skin. Superficial phlebitis is phlebitis that is in a superficial vein under the surface of the skin.
Deep vein thrombophlebitis refers to a blood clot causing phlebitis in the deeper veins. Deep vein thrombophlebitis is also referred to as deep venous thrombophlebitis, deep vein thrombosis DVT.
The presence of superficial phlebitis does not necessary suggest an underlying DVT. Upper extremity upper limbs and lower extremities lower limbs superficial thrombosis or phlebitis are typically benign conditions and have a favorable prognosis, Thrombophlebitis Form. A blood clot thrombus in the saphenous vein may be an exception. This is the large, long vein on the inner side of the legs. Thrombophlebitis in the saphenous vein can sometimes be associated with underlying deep vein thrombophlebitis.
On the other hand, deep Thrombophlebitis Form thrombosis of the upper and lower extremities can be a more serious problem that can lead to a blood clot traveling to the blood vessels of the lungs and resulting in pulmonary embolism.
Pulmonary embolism can injure lung tissue is serious and occasionally fatal. What are the risk factors for phlebitis? What are the symptoms of phlebitis? Phlebitis, Thrombophlebitis Form, if mild, may or may not cause symptoms.
Paintenderness, redness erythemaand bulging of the vein are common symptoms of phlebitis. The redness and tenderness may follow the course of the vein under the skin. Low grade fever may accompany superficial and deep phlebitis. High fever or drainage of pus from the site of thrombophlebitis may suggest an infection of the thrombophlebitis referred to as septic thrombophlebitis.
Palpable cords along the course of the vein may be a sign Thrombophlebitis Form a superficial clot or superficial thrombophlebitis.
A deep venous thrombosis may present as redness and swelling of the involved limb with pain and tenderness. In the leg, this can cause difficulty walking. How is phlebitis diagnosed? The diagnosis of superficial phlebitis can be made based on the physical examination by a physician. Warmth, tenderness, redness, and swelling along the course of the vein is highly suggestive of superficial phlebitis or thrombophlebitis.
An ultrasound of the area can help in making the diagnosis of phlebitis or excluding it. Deep vein thrombosis is more difficult to diagnose on the basis of clinical examination.
The strongest clinical indicator is unilateral extremity swelling, which may be associated with pain, Thrombophlebitis Form, warmth, redness, discoloration or other findings.
The most commonly Thrombophlebitis Form imaging test for diagnosis of deep vein thrombosis is ultrasound. It is less expensive than alternatives and highly reliable. In many settings, however, it is simply not available 24 hours per day. Other imaging tests of benefit in specific situations include - but are not limited to - CT scanMRI scan and venography phlebography.
D-dimer is a useful blood test that can suggest phlebitis. This is a chemical that is released by blood clots when they start to degrade. A normal D-dimer makes the diagnosis Thrombophlebitis Form thrombophlebitis unlikely. The limitation of this test is its lack of specificity, meaning that an elevated D-dime level can be Thrombophlebitis Form in other conditions including recent surgery, fall, pregnancy, or an underlying cancer.
Conditions that mimic phlebitis include cellulitis superficial skin infectioninsect bites, Thrombophlebitis Form, Vitebsk Krampfadern in den Beinen lymphangitis swelling and inflammation of lymph nodes and can be distinguished by obtaining a careful Thrombophlebitis Form history and physical examination by a physician.
Sometimes, Thrombophlebitis Form, a biopsy of the skin may be required to establish the definite diagnosis. How is phlebitis treated? Treatment of phlebitis may depend on the location, extent, symptoms, and underlying medical conditions.
In general, superficial phlebitis of the upper and lower extremities can be treated by applying warm compresses, elevation of the involved extremity, encouraging ambulation walkingand oral anti-inflammatory medications ibuprofen [ MotrinThrombophlebitis Form, Advil ], diclofenac Thrombophlebitis Form VoltarenCataflamVoltaren-XR], etc, Thrombophlebitis Form.
Topical anti-inflammatory medications may also be beneficial, such Thrombophlebitis Form diclofenac gel. External compression with fitted stockings is also a recommended for patients with superficial phlebitis of the lower extremities.
If an intravenous catheter is the cause, then it should be removed. If the phlebitis is infected, then antibiotics are used. In severe cases of infected thrombophlebitis, surgical exploration may be necessary.
Superficial thrombophlebitis blood clots is evaluated Thrombophlebitis Form an ultrasound to exclude deep venous thrombophlebitis, especially those involving the saphenous vein.
If deep venous thrombophlebitis is suspected or diagnosed, or if its risk of Thrombophlebitis Form is considerable, then anti-coagulation thinning of blood may be necessary, Thrombophlebitis Form.
This is typically done by injection of low molecular weight heparin enoxaparin [ Lovenox ]or by injection of fondaparinux Arixtra. It can be done by treatment with therapeutic dosages of unfractionated heparin usually in the form of an intravenous dripfollowed by oral anti-coagulation with Thrombophlebitis Form Coumadin for about 3 to 6 months.
Newer anticoagulants may replace Coumadin in certain circumstances. Patients with extensive deep vein thrombosis DVT may be appropriately treated with catheter-directed thrombolysis in selected cases, but will still require maintenance anticoagulation for 3 to 6 months.
Selected patients with DVT may require placement of inferior vena cava filters to help prevent pulmonary embolus. In a subset of patients, Thrombophlebitis Form, it may be appropriate to remove the filter at a future date.
Recovery of symptoms from superficial phlebitis can last a few weeks. A thrombophlebitis may take weeks to months to recover. What are the complications of phlebitis? Complications of phlebitis may include local infection and abscess formation, clot formation, and progression to a deep venous thrombosis and pulmonary embolism. When pronounced deep venous thrombophlebitis has seriously damaged the leg veins, Thrombophlebitis Form, this can lead to post-phlebitic syndrome.
Post-phlebitic syndrome is characterized by chronic Thrombophlebitis Form of the involved leg and can be associated with leg paindiscoloration, and ulcers. Can phlebitis be prevented? Compression stockings are Thrombophlebitis Form in many patients after an episode of phlebitis, especially deep venous phlebitis. These, and other measures, reduce post-phlebitic swelling and the risk of recurrent phlebitis.
In most hospitalized patients who have limited mobility or have had recent orthopedic surgery, a low dose of blood thinners heparin, fondaparinux, enoxaparin [Lovenox] or other agents may be injected routinely in order to prevent blood clot formation by keeping the blood relatively thin. This preventive dose is generally lower than the doses used for treating existing blood clots.
A widely used alternative is the use of intermittent compression garments on the extremities during periods of high risk. Medically reviewed by Robert J. A painful, swollen leg may be one sign of a dangerous clot. Blood clots can occur in the venous and arterial vascular system.
Blood clots can form in the heart, legs, arteries, Thrombophlebitis Form, veins, bladder, urinary tract and uterus. Risk factors for causes of blood clots include. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot, Thrombophlebitis Form.
Blood clots can be prevented by lowering the risk factors for developing blood clots. Deep vein thrombosis DVT is a blood clot in the deep veins, and can be caused by broken bones, trauma to a limb, immobility, Thrombophlebitis Form, medications, smoking, cancer, genetic predisposition, Thrombophlebitis Form, and cancer.
Symptoms of a deep vein thrombosis in a leg are, Thrombophlebitis Form. Signs and symptoms of pregnancy vary by stage trimester. The earliest pregnancy symptom is typically a missed period, but others include. Eating a healthy diet, getting a moderate amount of exercise, Thrombophlebitis Form, also are recommended for a healthy pregnancy.
Information about the week by Die Behandlung von Krampfadern Neumyvakin growth Thrombophlebitis Form your baby in the womb are provided. Pregnancy planning is an important step in preparation for starting or expanding a family. Planning for a pregnancy includes:. Pregnancy symptoms can vary from woman to woman, and not all women experience the same symptoms.
When women do experience pregnancy symptoms they may include symptoms include, Thrombophlebitis Form. Symptoms in late pregnancy include leg swelling and shortness of breath. Options for relief of pregnancy symptoms include exercise, diet, and more.
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