By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
Phlebitis is the inflammation of a blood vessel. Thrombophlebitis is when that vessel develops a blood clot in it. Some people just use the term phlebitis but the correct terminology when there is a clot present is thrombophlebitis. These terms are used for occurrences in the superficial venous system. When it happens in the deep venous system, it is referred to as a deep venous thrombosis or DVT. A deep system blood clot is much more dangerous than those that are in the superficial system because there is a greater risk of the clot dislodging and traveling to the heart, lungs or brain.
Inflammation of veins and blood clots that form in the superficial system most of the time are not dangerous unless they are located very close to where the superficial system and the deep system connect. When inflammation and blood clots form in the superficial venous system it is usually the body’s way of destroying a bad vein. When veins are diseased they become over dilated and the one way valves within the veins become weak and fail. This allows blood to travel in the wrong direction causing it to become stagnant. Stagnant blood becomes deoxygenated and has sluggish flow allowing clot formation to develop. When a clot forms, the body tries to breakdown and reabsorb it resulting in an inflammatory response.
Symptoms of a superficial thrombophlebitis are usually localized redness, warmth, and a firm area that feels like a cord. It can be just a small area that feels like a knot or it can feel like a cord that extends from the groin to the ankle or anything in between. A deep venous system clot causes the entire leg to be painful, particularly in the calf area that increases when you try to pick up your toes or flex your foot. The leg tends to swell and the discomfort is difficult to localize to one specific area. When the deep system is occluded, the entire leg becomes congested due to interruption in the drainage of the blood from that leg into the general circulation and the body relies on the superficial system to drain the limb which is not as efficient as the deep system.
The body can usually break down and reabsorb the clots in the deep system but it sometimes can take up to a year. Rarely the clotted vein will be permanently destroyed and develop into scar tissue. When a superficial blood clot forms. The body can immediately re-route the blood into healthier veins. There are no essential vessels in the superficial system and sometimes these veins are also permanently destroyed by the body when a clot forms in them.
Over distended or varicose veins are the most common reason for developing superficial thrombophlebitis and once a clot develops the body is more prone to developing others. It puts the clotting system on “alert” and triggers the signals for clot formation. Dehydration, inactivity, travel, surgery, chemotherapy, trauma, pregnancy, hormone therapy, birth control pills or genetic factors can also increase a person’s risk of developing blood clots.
Usually a single episode of a superficial thrombophlebitis that is small and limited with an obvious cause does not need further evaluation and work up but recurrent episodes or a large area of involvement does. The medical evaluation for superficial thrombophlebitis usually includes an ultrasound to establish that the deep venous system is not effected and sometimes blood work to rule out a genetic clotting disorder. Oftentimes, people with genetic clotting disorders are not diagnosed until they develop recurrent blood clots.
Treatment for superficial thrombophlebitis includes application of heat to the area periodically to improve circulation to the area allowing the body to break down and reabsorb the clot, oral anti-inflammatory medications and compression therapy. Prescription anti-coagulant medications are generally not used unless there is a large area of involvement, the clot in the superficial vein is very close to the deep system or a genetic clotting disorder is present. Anti-coagulants do not breakdown and reabsorb the clots but it prevents the clot from becoming bigger or developing additional clots.
If you suspect you have a blood clot, it is always important to call your primary care provider for an evaluation to see what treatment is necessary. If you suffer from varicose veins or have had problems with blood clots in your legs, give us a call. We would be happy to evaluate you further.