The diagnosis of phlebitis 

Although a simple physical examination can diagnose superficial phlebitis, a venous ultrasound or an X-ray performed using a contrast medium should usually be done to detect the presence of blood clots in the deep veins. In practice, the most widely used test isDoppler ultrasound, which allows to visualize the blood flow in the veins⁶. Pain, swelling, discoloration of the skin, and a feeling of heat in the legs are signs that may prompt your doctor to do an ultrasound or x-ray.

Un blood test, intended to measure the level of D-dimer, a substance released by the clot, can sometimes be carried out to confirm the absence of phlebitis if the doctor is in doubt.

Treatments

If you have a superficial phlebitis, a local treatment, which can be done at home, is sufficient. Rest is advised, with elevation of the leg and application of lukewarm compresses to the affected region. The compresses can be applied for 15 to 30 minutes, 2 to 3 times a day. Wearing a venous retention is often advised for a few days or weeks. These are elastic bandages or stockings that lightly compress the calf or leg and thus help blood flow back to the heart.

The patient can also take anti-inflammatory drugs: the pain subsides within a few days, but the inflammation can persist for 2 to 3 weeks. Although there is no formal medical recommendation, a new treatment is sometimes recommended. It consists of taking anticoagulant drugs for a few days to 1 month. Anticoagulants (for example, heparin) prevent or delay the formation of clots in the blood, and also help to dissolve them.

Patients with varicose veins who have recurrent phlebitis may experience surgical removal part of the vein that is affected, a procedure commonly called stripping.

If you have a deep phlebitis, anticoagulant drugs are injected intravenously or subcutaneously as a matter of urgency to dissolve the blood clot. The most commonly used anticoagulant isheparin low molecular weight, injected daily for 5-7 days⁷. A newer medicine, fondaparinux (Arixtra®), can also be used.

After these initial injections, an oral anticoagulant treatment (warfarin or Coumadin®) is put in place, in order to avoid recurrence. This treatment will continue for a period ranging from 3 months to several years, depending on the patient and his risk factors. Usually, treatment lasts 6 to 12 months.

Daily wearing of compression stockings is also recommended from diagnosis and for at least 3 months. This helps reduce edema and prevent complications (especially post-thrombotic syndrome). As a general rule, bed rest should be as brief as possible.

In some cases, especially when taking anticoagulants is contraindicated, a filter may be placed in the inferior vena cava (which is located in the abdomen) to prevent the passage of clots to the lungs. . This procedure does not require hospitalization.

Sometimes the surgery is needed to remove a clot that is blocking a vein in the pelvis or abdomen (thrombectomie). You can also do an angioplasty to open the vein and put in place a stent (a small tube) that will keep the vein open.