Superficial Phlebitis

What is a Superficial Blood Clot?

When blood clots in the superficial veins of the leg, it is known as a superficial thrombophlebitis (or commonly, phlebitis). Patients often may experience pain and tenderness on the surface of the leg with appearance of a tender lump or streak. Many times, patients recall a varicose vein in the same area prior to the phlebitis appearing. Varicose veins are a well-recognized risk factor for superficial thrombophlebitis. While phlebitis confined to the surface veins does not pose the same serious risk as DVT, we know that some patients with phlebitis progress to DVT as that surface clot extends to the deep venous system. Since superficial clots and deep clots may co-exist, we often perform a venous duplex ultrasound examination to detail the extent of the process.

What Causes Superficial Phlebitis?

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Many factors have the potential to increase your risk of blood clot. Some of the common ones are:

  • An inherited blood clotting disorder
  • Prolonged bed rest or immobility (chronic disease, injury or prolonged surgery, long flights)
  • Birth control pills
  • Smoking
  • Cancer
  • Varicose veins
  • Local leg trauma

 

Treatment of Superficial Phlebitis

The goals of superficial phlebitis treatment are to reduce the pain, prevent clot extension, and diagnose any underlying venous issue that may predispose to recurrent clot formation.

 

Initially, anti-inflammatory medications like Ibuprofen are helpful. Symptom resolution may take several weeks. Extensive phlebitis, especially those cases where the surface blood clot is very close to the deep veins, may be treated with blood thinners such as Coumadin, Xarelto, Eliquis or Heparin. The anticoagulant medications can help prevent the surface clot from extending into the deep veins. Your physician will discuss these options with you. Maintenance of normal activity is helpful.

 

Since varicose veins are commonly associated with superficial phlebitis, it is important to have a thorough evaluation of the venous system with respect to venous insufficiency (reflux). Normally, blood is propelled up the leg against gravity by one-way valves in the vein. If these veins weaken or become ineffective, backflow occurs, leading to elevated pressures, varicose veins, abnormal flow patterns, and blood clot.

 

If we identify venous reflux as a cause of the phlebitis, we often will advise endovenous ablation of the saphenous vein to normalize venous flow. Ablation is done with the office based procedures VNUS Closure, VenaSeal, or Clarivein, and all of these procedures allow immediate return to normal activity. Associated surface varicosities are then taken out of the body with micro-phlebectomy, again an office procedure allowing return to normal activity. The restoration of normal venous flow is an important component in the maintenance of optimal leg health.