Thrombophlebitis

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Classification according to ICD-10
I80.- Thrombosis, phlebitis and thrombophlebitis
ICD-10 online (WHO version 2019)

Thrombophlebitis is the medical term for acute thrombosis and inflammation of superficial veins . In contrast, a thrombosis of the deep veins (leading vein system) is called a phlebothrombosis .

causes

The exact cause of most cases of superficial phlebitis is unclear. Acute inflammation of the vein wall due to mechanical or chemical irritation (e.g. from peripheral venous catheters ) as well as the infiltration of germs is assumed. The release of inflammatory mediators from a blood clot is also discussed. Why the inflammation occurs much less often in deep vein thromboses has not yet been clarified. It is not uncommon for a superficial vein to have inflammatory thrombophlebitis as well as thrombotically occluded vein sections without inflammation.

Risk factors for superficial thrombophlebitis on the leg are

A typical thrombophlebitis, which is often also bacterially infected, occurs after injury to the vein wall from the outside, for example after venipuncture. The localization is usually the arm. Phlebothrombosis that is not initially inflamed can also lead to the development of thrombophlebitis. In the end, the vein is usually blocked by clotted blood and inflammation not only of the entire vascular wall, but also of the surrounding connective tissue.

Symptoms, complaints

Typical symptoms of an inflammatory process usually appear :

  • Redness over the affected vein and mostly also in the surrounding area
  • Swelling (small compared to phlebothrombosis) and the formation of a hard cord in the course of the vein
  • Pain that usually increases significantly when touched

Diagnosis

Palpable finding and aspect

The presence of thrombophlebitis can initially be determined easily and relatively reliably based on the symptoms (see above).

Ultrasonic

However, it is problematic that it cannot be determined how far the thrombophlebitis z. B. in a great saphenous vein on the lower leg extends up into the groin and whether it has already broken into the leading vein system. An ultrasound examination ( sonography ) is therefore required in order to determine the extent of the thrombophlebitis and at the same time to rule out phlebothrombosis.

Differential diagnoses

therapy

Certainly effective

  • Cooling (analgesic and anti-inflammatory) with quark compresses, ice cube packs, cooling elements or alcohol packs
  • Anticoagulation with heparin in the case of extensive findings or lengthy healing process
  • Pain treatment with acetylsalicylic acid , ibuprofen , diclofenac
  • Surgical procedure: stab incision and squeezing out the clot, removal of the affected veins, especially in the case of extensive varicophlebitis
  • no bed rest, but normal exercise as swelling and pain allow
  • Compression therapy : Wrap with short-stretch bandages or compression stocking , often not possible at the beginning because of the severe pain

Controversially effective

Not yet systematically investigated

course

The further course of superficial thrombophlebitis is usually benign. The vein becomes stuck, after a while it heals completely or is recanalized again. Sometimes you can also find calcifications in the veins as a result of thrombophlebitis. Bacterial colonization can cause septic or purulent thrombophlebitis.

In contrast to phlebothrombosis, complications such as pulmonary embolism and long-term damage such as post-thrombotic syndrome rarely occur with superficial thrombophlebitis in the lower leg area . Thrombophlebitis in the thigh area always involves a potential risk of pulmonary embolism and should always be treated surgically by crossectomy and then with anticoagulants (low molecular weight heparin or rivaroxaban for at least three months) and compression stockings.

literature

Individual evidence

  1. ↑ G. Münch, J. Reitz (Ed.): Fundamentals of the theory of diseases. Nikol, Hamburg 1996, ISBN 3-933203-06-6 .