Thrombophlebitis

Thrombophlebitis is the medical term for acute thrombosis and inflammation of mostly superficial veins. In contrast, one speaks in a deep vein thrombosis ( Leitvenensystem ) from a DVT.

  • 5.1 Safe effective
  • 5.2 Controversial effective
  • 5.3 So far, not been studied systematically

Causes

The exact cause of most cases of superficial phlebitis is unclear. An acute inflammation of the vein wall by mechanical or chemical irritation ( for example, by peripheral venous catheter ), as well as the nuclei of Einschwemmung adopted. Also a release of inflammatory mediators from a blood clot is discussed. Why the inflammation occurs more rarely in the deep venous thrombosis, has not been elucidated. Not infrequently, is also found in the course of a superficial vein thrombophlebitis next to an inflammatory and thrombotic occluded vein segments without inflammation.

Risk factors of superficial thrombophlebitis in the leg are

  • Chronic damage of the vein wall (eg varicose veins )
  • Inflammatory and systemic diseases (eg cancer, thromboangiitis obliterans ),
  • Coagulation disorders,
  • Nicotine consumption and
  • Seniority

A typical thrombophlebitis, which is often also infected by bacteria, can be found after injury of the vein wall from the outside (eg by venipuncture and venous catheters ). The localization is usually the arm. Even an initially non- inflamed DVT can lead to the development of thrombophlebitis. At the end of regular way is the closure of the vein by clotted blood and inflammation not only of the entire vessel wall, but also of the surrounding connective tissue.

Symptoms, complaints

It usually occur typical symptoms of an inflammatory process to:

  • Redness over the affected vein and usually surface in the surrounding area
  • Swelling ( low compared to the DVT ) and forming a hard strand in the course of the vein
  • Pain, which increase significantly when touched most

Diagnostics

Palpation and aspect

The presence of thrombophlebitis is based on symptoms (see above), first determine simple and relatively safe.

Ultrasound

The problem is that this can not be determined how far the Thrombophlebits ranges eg in a saphenous vein in the lower leg up to the bar, and whether it is already broken into the Leitvenensystem. To ask therefore is an ultrasound (sonography) to determine the extent of thrombophlebitis and at the same time exclude a DVT.

Differential Diagnosis

  • Phlebothrombosis
  • Erysipelas ( diffuse and areal, more general symptoms, especially chills)
  • Erythema nodosum
  • Lemierre 's syndrome

Therapy

Certainly effective

  • Cooling ( analgesic and anti-inflammatory) by Quark packs, ice packs, cooling elements or alcohol Envelopes
  • Anticoagulation with heparin in extensive findings or protracted course of healing
  • Pain treatment with aspirin, ibuprofen, diclofenac
  • Surgical procedure: incision and expressions of the clot, removal of the affected veins, especially during extended varicophlebitis
  • To the extent permitted no bed rest, but normal movement swelling and pain
  • Compression Therapy: Wrap with bandages or compression stocking, not possible at the beginning because of the severe pain often

Controversial effective

  • Nonsteroidal antiinflammatory drugs locally as an ointment
  • Heparin albums associations

So far, not been studied systematically

  • Cortisone
  • Antibiotics

Course

Most of the further course of a superficial thrombophlebitis is benign. The glued vein, after some time they healed completely or recanalized again. Sometimes you can also calcifications in the veins as a result of thrombophlebitis. By bacterial colonizations septic or suppurative thrombophlebitis also can occur.

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

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