Superficial Phlebitis, Superficial Venous Thrombosis (SVT), Deep Vein Thrombophlebitis (DVT,) Venous Thromboembolism (VTE) and Post Phlebitic Syndrome
Venous thrombosis (a blood clot in the veins) is the condition where the vein becomes obstructed by a clot which prevents the normal return of blood from the legs to the heart. This causes swelling, pain and inflammation in the vein and in severe cases can comprise the viability of the skin and the deep muscle compartment causing phlegmasia cereula dolens (painful blue leg), or even progress to venous gangrene known as phlegmasia alba dolens (painful white leg). Fortunately these complications are quite rare and can be treated by interventional specialist with mechanical and enzymatic clot dissolution systems. If a clot in the deep venous system extends or breaks free (Venous Thromboembolism) and it is carried up to the heart it will be pumped into the lungs. This is known as a pulmonary embolus (PE) and is a potentially life threatening event. Fortunately this condition, like DVT, can be dealt with by hospital based interventional specialists.
Traditionally venous phlebitis has been classified as Superficial Vein Phlebitis and Deep Vein Thrombophlebitis but it is becoming clear that the two are clearly related.
Superficial Venous Phlebitis often starts out as a tender, red, warm and firm segment in the superficial veins and can be appreciated as a palpable tender cordlikesegment of vein just below the skin. This occurs most often in an incompetent segment of the Great Saphenous Vein and is associated with pregnancy, obesity, smoking, and the use of oral contraceptives. It can remain relatively isolated in the calf or thigh, or travel towards the deep veins of the calf or thigh. If the inflammation and clot in the superficial veins extends into the Deep Venous System it becomes a Deep Vein Thrombosis (DVT). Superficial Venous Thrombosis (SVT) within 2 cm of the Saphenofemoral Junction or the Saphenopopliteal Junction is clinically considered to be a like a DVT. The conservative standard of care is to treat SVT with warm compresses, elevation, anti-inflammatory pain medications (NSAIDs like Feldene, Mobic, Naprosyn, Naproxen and Celebrex) and compression stockings. This standard is being replaced by a newer proactive approach which initially employs outpatient anticoagulant injections such as Lovenox or Enoxaprin, then continuing the patients on oral Coumadin (generic Warfarin). Anticoagulants control the risk of SVT becoming a DVT and allow the body to more quickly dissolve these initial clots and relieve the associated pain and swelling. A limited drainage procedure under local analgesia will also give dramatic pain relief if clinically indicated. Coming soon.