What Is Thrombophlebitis?

Thrombophlebitis refers to the inflammation of a vein caused by a blood clot (thrombus). This type of inflammation frequently occurs in the legs but can occur in other body areas. A blood clot is a clump of blood cells held together by protein.

Thrombophlebitis occurs near the skin's surface or in deeper veins. The blood clots can interfere with normal flow. Depending on the severity, they could put your life at risk.

This article will cover thrombophlebitis symptoms, causes, diagnosis, treatment, and more. 

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Types of Thrombophlebitis

There are two main types of thrombophlebitis: superficial and deep vein.

Superficial Thrombophlebitis

Superficial thrombophlebitis occurs in the veins just below the skin's surface. It can affect the leg or the arm. You usually do not feel pain with superficial thrombophlebitis, and it may clear on its own without treatment. With some time, the blood clot will eventually break apart, and blood flow will resume.

Superficial thrombophlebitis is sometimes a sign of deep vein thrombosis (DVT), a more serious condition requiring treatment.

There are different subtypes of superficial thrombophlebitis. These are:

• Sterile superficial thrombophlebitis: This subtype accounts for most superficial thrombophlebitis incidences and occurs without infection.
• Traumatic superficial thrombophlebitis: This subtype occurs after a limb injury or bruising of surrounding tissues. 
• Infective thrombophlebitis: This subtype will occur after an intravenous (IV) line insertion that causes an infection and leads to thrombophlebitis. 
• Migratory thrombophlebitis: This subtype refers to recurrent superficial thrombophlebitis at various body sites. It has no identifiable cause.
  

Deep Vein Thrombosis 

Deep vein thrombosis occurs when a blood clot forms in one or more deep veins, often in the legs. Some people may experience pain and swelling, but most have no noticeable symptoms.

DVT is a serious condition because blood clots can break loose and travel through the bloodstream. They might get into the lungs and block flow—a condition called pulmonary embolism. The combination of these two conditions is known as venous thromboembolism (VTE).

Thrombophlebitis Symptoms

The symptoms of thrombophlebitis will vary based on the type.

Superficial vein thrombophlebitis might cause the following symptoms:

• Swelling of the affected vein 
• Redness along the superficial vein  
• Warmth and tenderness of the affected area
• Itching of the skin in the affected area
• Pain 
• Hard lumps just below the skin
• Skin breakdown in the affected area

DVT primarily affects the large veins in the lower leg or thigh on one side of the body. The clot can block blood flow and cause the following symptoms:

• Leg pain, swelling, and tenderness of the thigh or calf
• Skin that is warm to the touch
• Red skin discoloration or red streaks on the skin

If a pulmonary embolism is present, there will be limited blood supply to the lungs. Symptoms of PE might include:

• An unexplained shortness of breath
• Rapid breathing or a fast heart rate
• Chest pain under the ribcage
  

You will want to watch out for infection at the site of thrombophlebitis. This is called septic thrombophlebitis, which can occur with both superficial and deep venous thrombophlebitis. The infection can appear as an abscess—a tender mass filled with pus. 

When the deep vein thrombophlebitis causes vein damage, it leads to postphlebetic syndrome, also called post-thrombotic syndrome. It primarily causes chronic swelling and pain in the affected vein area. 

Causes

A blood clot is the cause of thrombophlebitis. Blood clots can be caused by inactivity, including from being bedridden and sitting for too long. Movement promotes circulation, which might reduce the risk of a blood clot.  

You could also develop a blood clot if you experience an injury to a blood vessel or sustain an injury from an IV needle or catheter. But this is a less common cause of a blood clot. 

There are also risk factors that cause blood to clot more easily. Such risk factors include:

• Atherosclerosis (buildup of plaques in the arteries)
  
• Atrial fibrillation (rapid and chaotic irregular heart rhythm)
• Cancer and cancer treatments
• Some genetic disorders
• COVID-19
• Diabetes
  
• A family history of blood clots
• Being overweight
• Pregnancy and giving birth
• A serious injury to a blood vessel
• Some medicines, including birth control bills
• Smoking
  

Superficial thrombophlebitis might recur in people with varicose veins—twisted, enlarged veins at the skin's surface.

Diagnosis

Many cases of thrombophlebitis are diagnosed in the emergency room because the symptoms can be alarming. Because blood clots can be dangerous, it is a good idea to seek out immediate medical help.

At the emergency department, a healthcare provider will ask about your health and medical history, including what medicines you are taking. After learning about your medical history, they will ask about your symptoms, when they started, and how long you have had them.

Duplex ultrasonography is the most common tool used to diagnose thrombophlebitis. This test uses sound waves to examine blood flow in the veins. It can also detect blockages in the deep veins. 

The healthcare provider might also order a D-dimer test. This blood test measures a substance in the blood that is released when a clot breaks apart. If this test is negative, there is no blood clot. 

Additional imaging for thrombophlebitis includes contrast venography. This is a special type of X-ray in which a contrast dye is injected into a large vein in the foot or ankle to help the healthcare provider see the deep veins of your leg and hip.

While contrast venography is accurate for diagnosing blood clots, it is an invasive procedure. Healthcare providers prefer to use duplex ultrasonography and only use contrast venography in exceptional circumstances. 

Treatment

After diagnosis and identification of superficial thrombophlebitis, most people can treat the condition at home. Your healthcare provider may recommend the following as part of your treatment plan:

• Application of heat
• Wearing support stockings
• Keeping your affected arm or leg elevated 
• Using anti-inflammatory drugs like Advil (ibuprofen) and Aleve (naproxen) 
• Taking antibiotics
  

Some people might need surgery to remove the affected vein, either due to pain or the appearance of the vein. This procedure is called vein stripping and doesn't affect circulation. 

People who have superficial thrombophlebitis do not typically need blood thinners. They might be prescribed if you have a clot in or near a deep vein to reduce the potential for it becoming a DVT.

If you are diagnosed with a DVT, you will be sent home either with blood thinning medicines that are injected or taken by mouth.

Additional treatments for DVT are:

• Thrombolytics: These medications work to dissolve the clot. They increase the risk of bleeding and are only prescribed when anticoagulants (blood thinners) cannot be used or have not been helpful.
• Inferior vena cava filter: This filter is inserted inside the inferior vena cava, the large vein that brings blood back to the heart. It captures clots moving through the veins before they get to the lungs.
• Surgery: Thrombectomy involves the removal of a clot in someone with a DVT. Embolectomy removes a blockage in the lungs of someone with PE.
  

Prognosis 

Superficial thrombophlebitis is a short-term condition that rarely causes complications, although some people might experience an infection or DVT. Your full recovery might take up to a few weeks. Hardening of the vein might occur and add to healing time. Infection or DVT might also add to your healing time.

A DVT or PE can take several months to dissolve fully. Blood-thinning medicines and compression stockings can help facilitate your full recovery. Your healthcare provider will request blood tests and ultrasounds to monitor you and determine if the blood clot is still in place.

You may experience recurrent episodes of superficial thrombophlebitis if you have varicose veins. 

Summary 

Thrombophlebitis is inflammation of a vein caused by a blood clot in the leg or another body area. It occurs near the skin or deep down in the muscle layers. The blood clot can interfere with normal blood flow. Many different conditions and risk factors can put you at risk for blood clots, including obesity, genetic disorders, varicose veins, and family history. 

The two types of thrombophlebitis are superficial thrombophlebitis and deep vein thrombophlebitis. The superficial type is usually harmless and is treated with home remedies, anti-inflammatories, and antibiotics, but it might also be a sign of a DVT. DVTs are treated with anticoagulants, thrombolytics, a special filter procedure, and surgery.