Wandering superficial thrombophlebitis

Wandering superficial thrombophlebitis is recurrent inflammation of the veins with a variable location. It can affect both the lower and upper limbs. The ailment occurs mainly in women and is usually without complications. Some patients may additionally develop deep vein thrombosis, which increases the risk of pulmonary embolism.

What is itinerant superficial thrombophlebitis?

It is an inflammation that occurs in the venous vessels located above the deep fascia, accompanied by a thrombus in the lumen of the vessel. Thrombotic inflammation most often affects the lower limbs and is associated with the presence of varicose veins. Inflammation can also occur in the upper limbs, then it is associated with the presence of a catheter in the vein or other medical procedures performed.

The risk of clot detachment and embolism is relatively small because it adheres very tightly to the vessel wall, but the mere presence of superficial thrombophlebitis is very symptomatic. This ailment usually occurs in women between the ages of 30 and 60 who respond well to conservative treatment. Although the disease usually does not cause any complications, a certain group of patients may have deep vein thrombosis, which increases the risk of pulmonary embolism.

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The causes of wandering superficial thrombophlebitis

The formation of varicose veins in the lower limbs is related to the stagnation of blood, which causes the formation of clots and inflammation. So what increases the risk of this ailment?

1. Infection – an infection that has attacked the body can thus attack the veins (spreading through the surrounding tissues) or spread through the blood (in the case of sepsis).

2. Medical activities (iatrogenic causes). In some patients, superficial thrombophlebitis occurs due to the insertion of a catheter into the vein of the upper limb infected by bacteria located on the skin (eg, Staphylococcus epidermidis). Inflammation can also occur as a result of intravenous administration of certain preparations, e.g. penicillin or potassium, and a contrast agent.

3. Idiopathic causes – we are talking about them when the factor that caused the disease cannot be determined.

4. Mechanical damage / injuries – the disease may occur due to damage to the epithelium that lines the lumen of the vein, which results in the formation of intravascular clots.

The location of the clot near the exit of the leg vein into the femoral vein increases the risk of the clot moving into the deep vein system and the development of venous thrombosis. Then, swelling develops as a result of blockage of the venous outflow.

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Poniżej przedstawiono pozostałe czynniki zwiększające ryzyko powstawania żylaków:

1. gender – varicose veins are more common in women, because female hormones relax collagen fibers and muscles that build the vascular wall;
2. age – the risk of varicose veins increases with age;
3. genetic predisposition – some have genetically incorrect structure and composition of collagen;
4. taking hormones;
5. sitting or standing work / lifestyle – causes venous stasis; on the other hand, due to gravity, blood collects in the veins of the lower extremities, causing high pressure on the walls of the vessels to widen them;
6. pregnancy – varicose veins have been observed in about 20% of pregnant women;
7. a factor related to medical interventions, e.g. type of material the catheter is made of; catheter size (large catheters make contact with a larger area of ​​the vessel wall); location of the catheter (placing it near the joints makes it easier to move and thus damages the vessel wall); catheter holding time (longer than 48 hours increases the risk of thrombosis); poor disinfection of the area where the catheter is placed leads to bacterial infection; rapid infusion of irritants leads to damage to the vascular wall.

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Wandering superficial thrombophlebitis – symptoms

Dzięki dobrej znajomości objawów towarzyszących zakrzepowemu zapaleniu żył powierzchownych możliwe jest wdrożenie odpowiednio wcześnie leczenia. W obrębie chorego naczynia żylnego oraz tkanek pojawia się:

1. uczucie (pod dotykiem) twardej żyły, który jest nadwrażliwa;
2. ból mający postać kłucia lub pieczenia;
3. ciepła skóra;
4. zaczerwieniona skóra.

In the case of acute superficial thrombophlebitis, general symptoms such as high temperature, malaise, increased heart rate and breathing, and disturbed consciousness are also added. They occur especially in the case of bacterial infection, abscesses and sepsis (rarely seen). However, the occurrence of deep vein thrombosis causes, apart from limb edema.

IMPORTANT! The occurrence of symptoms of migratory superficial thrombophlebitis should be immediately consulted with a doctor! This should be remembered especially by patients who develop limb edema that may lead to pulmonary embolism and thus death. Make an appointment with an internist today who will help ease the swelling and prevent the development of the disease.

These symptoms usually resolve on their own after about three weeks, although a hard and oversensitive vein may be felt for a long time.

Diagnostics of wandering superficial thrombophlebitis

The basis for the diagnosis of superficial thrombophlebitis is the medical history of the patient and the assessment of the existing changes visible in the physical examination. As a rule, there is no need to perform additional tests, but there are cases when they should be performed. In the case of catheter-related inflammation, the material is inoculated from the tip of the catheter – the result is very likely to reveal what factor caused the inflammation.

Imaging tests are also used in the diagnosis of thrombophlebitis, including ultrasound using the duplex-Doppler method, thanks to which it is possible to simultaneously assess blood flow and morphological changes. This type of examination is performed primarily in patients with suspected deep vein thrombosis that may coexist with superficial thrombophlebitis.

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Treatment of wandering superficial thrombophlebitis

1. Causal treatment – is based on removing the infected catheter from the vein (eliminating the source of infection is the basis of treatment) and putting on elastic stockings that significantly reduce the stagnation of venous blood. The greatest pressure is exerted on the foot and it gradually decreases towards the thigh, which facilitates the drainage of blood from the lower limbs. These types of stockings are put on during the day (take them off at night). The patient’s symptoms of infection are treated with antibiotics that act on the source of the infection (staphylococcus).

2. Symptomatic treatment – Its purpose is to alleviate the symptoms of inflammation. NSAIDs – non-steroidal anti-inflammatory drugs – work well for redness and pain. Ideally, they are injected by the intramuscular route – after the inflammation is under control, therapy can be continued via the oral or rectal route. Note: Non-steroidal anti-inflammatory drugs can be taken for up to three weeks because they have many side effects, including disrupting bone marrow function. If there is a need for longer use – these drugs are recommended in the form of ointments.

In the case of deep vein inflammation, heparin is administered in the form of subcutaneous injections. It should be used for a minimum of four weeks. Another type of treatment is the use of oral anticoagulants.

3. Leczenie operacyjne — istnieją przypadki, w których konieczne jest leczenie operacyjne. Zalecane jest ono u pacjentów, u których zakrzepowe zapalenie żył znajduje się blisko ujścia żył podudzia do żyły udowej, ponieważ istnieje wysokie ryzyko, że rozwinie się zakrzepica żył głębokich. Zabieg operacyjny przeprowadzany jest, gdy skrzep znajduje się od połączenia z żyłą udową w odległości mniejsze niż trzy centymetry. Podczas operacji lekarz podwiązuje zaatakowaną stanem zapalnym żyłę przed jej ujściem do żyły udowej. Dzięki temu hamowane jest dalsze rozszerzanie się skrzepu. Zabieg może być wykonywany w znieczuleniu ogólnym.

important: Even if no treatment is given, the disease will disappear on its own within a few days / weeks. However, treatment should be initiated to prevent possible complications.

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How to prevent traveling of superficial thrombophlebitis?

The methods of preventing varicose veins are presented below.

1. Staraj się unikać długotrwałego siedzenia z założoną nogę na nogę, stania oraz siedzenia.

2. If you do sedentary work, take breaks for a walk (it can be even a few steps, stretching your legs).

3. Uprawiaj sport. Może to być jogging, spacery, pływanie lub jazda na rowerze.

4. While sitting, legs should be straightened and placed above the level of the torso.

5. Unikaj noszenia obcisłych ubrań oraz butów na wysokim obcasie.

6. While sleeping, place your legs on a pillow above the level of your torso.

7. Do not overheat the limbs by prolonged hot baths and sunbathing.

8. Należy unikać obecności cewnika powyżej 48 godzin.

9. Zanim wprowadzony zostanie cewnik należy zdezynfekować okolicę wkłucia

10. Narrow catheters with a maximum of 45 mm are better.

11. Catheter placement around joints should be avoided.

12. In the event of a long-term infusion into a vein, heparin may be added to the fluid to avoid the formation of blood clots.

Aby zapobiegać wędrującemu zakrzepowemu zapaleniu żył, wykonaj badanie chorób genetycznych, które pomoże określić czy jesteś nosicielem mutacji typu Leiden w genie F5, odpowiedzialnego za rozwój schorzenia. W profilaktyce zakrzepicy warto stosować Ekologiczny sok z brzozy z polskich lasów.

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