Superficial vein thrombosis
| Superficial vein thrombosis | |
|---|---|
| Great saphenous vein thrombosis | |
| Specialty | Vascular surgery |
| Symptoms | Pain, redness, and a palpable cord at the site of the blood clot. |
| Complications | May propagate to deeper veins where it can form a deep vein thrombosis or pulmonary embolism |
| Risk factors | An indwelling venous catheter is a risk factor for SVT in the arms. Venous stasis (such as from varicose veins, chronic venous insufficiency, or venous reflux) is a major risk factor for SVT in the legs. Other risk factors include pregnancy, cancer, trauma to limb, recent surgery, history of venous thromboembolism, hypercoagulability (thrombophilia) and recent immobilization of a limb. |
| Diagnostic method | May be made as a clinical diagnosis based on signs and symptoms. In other cases a venous duplex ultrasound establishes the diagnosis. |
| Differential diagnosis | Deep venous thrombosis, soft tissue infections such as cellulitis, insect bites, inflammation of superficial veins without blood clot (superficial phlebitis), lymphangitis, erythema nodosum |
| Treatment | Low risk SVT: pain management. High risk (high risk of blood clots in deeper veins): blood thinners. |
| Medication | Blood thinners such as fondaparinux, rivaroxaban, low-molecular weight heparins such as enoxaparin. Symptomatic relief: topical or oral Non-steroidal anti-inflammatory drugs (caution of bleeding if combined with blood thinners) |
Superficial vein thrombosis (SVT) is a blood clot formed in a superficial vein; a vein near the surface of the body. Usually there is thrombophlebitis, which is an inflammatory reaction around a thrombosed vein, presenting as a painful induration (thickening of the skin) with redness. SVTs have a lower disability and mortality risk compared to deep vein thrombosis (DVT), which occur deeper in the body at the deep venous system and have a greater risk of travelling to the lungs as pulmonary emboli. However, SVTs carry a risk of propagating (spreading) to become DVTs, which may then develop into PEs. If the blood clot is too near the saphenofemoral junction there is a higher risk of pulmonary embolism, a potentially life-threatening complication.
SVTs commonly occur in the arms and legs. The great saphenous vein (73% of lower extremity clots) and the small saphenous vein (25.7%) are the most commonly involved leg veins to develop SVTs. The cephalic vein (57% of upper extremity clots) and the basilic vein (14%) are the most common veins involved in SVTs of the arms. Blood pooling in the veins of the legs (due to inadequacy of veins to return blood to the heart) is a major risk factor for SVTs of the legs. Common causes of chronic venous insufficiency include varicose veins, or dysfunction of the venous valves causing blood pooling in the legs. Whereas placement of peripheral venous catheters (usually for longer than 40 hours) is a major cause of SVTs in the arms. Other risk factors include pregnancy, cancer, trauma to a limb, recent surgery, history of deep vein thormobses, high predisposition to form blood clots (thrombophilia) and immobilization of a limb.
Diagnosis is often based on symptoms. However, a doppler ultrasound is recommended if the diagnosis is unclear of if there is concern for a high risk SVT (high risk of propagating to a DVT or PE).
Symptomatic treatment may involve compression stockings, heat applied to the area, topical pain relievers, oral pain relieves or elevation of the affected limb. For high risk disease, blood thinners are recommended.