Introduction
Superficial thrombosis, also known as superficial thrombo-phlebitis (STP), is the formation of clotted blood in superficial veins. It usually occurs in varicose veins or veins damaged by intravenous cannula or medications.
Causes
Clot formation is usually precipitated by vein trauma, pooling of blood or an abnormal tendency for blood to clot.
The commonest cause of vein trauma is when a patient has had a cannula for intravenous medications. This is particularly an issue if the cannula is left in for too long or with some medications that are particularly irritant to the vein wall.
Pooling of blood is usually associated with varicose veins, where the large dilated and tortuous veins allow blood to pool. Wherever blood pools or is static then clot is likely to form.
A number of inherited clotting disorders exist that increase the risk of clot formation and will aggravate the above two situations.
Symptoms
STP causes a hard, painful red lump to form at the site of clot formation. It is a self-limited process that usually resolves over a period of 2-3 weeks. It can be very painful and is associated with significant inflammation. It is often mistaken for infection as the red area often becomes quite hot, however this is all due to inflammation not infection.
Tests
Clinical assessment is very useful as the features of STP are very typical. An ultrasound scan will clarify the diagnosis but is often not required. USS is very useful if there is concern that the thrombus could spread into the deeper veins and become a DVT.
Diagnosis
Ultrasound is the best investigation to confirm the presence of superficial thrombosis.
Treatment
The treatment for superficial thrombo-phlebitis is symptomatic. This involves the use of anti-inflammatory medications, gentle compression, cool packs, elevation and if particularly large clots form, or if they occur close to the deep veins, then blood thinning (anti-coagulation) is required.
The underlying cause also needs intervention. For clots associated with intra-venous cannula, then removal of the cannula is required as soon as possible.
If the STP is associated with varicose veins, then treatment for those varicose veins is important to prevent recurrence. Once STP has developed in varicose veins then it is likely to be a re-occurring problem.
If multiple episodes of STP develop in patients with a coagulation disorder, then it may be necessary to look at long term blood thinners (anti-coagulation).
Related Information
Varicose Veins
Spider and Reticular Veins
Endovenous Ablation of Varicose Veins
Sclerotherapy
Vein Stripping