When blood clots form in the superficial veins of the leg, it is known as a superficial thrombophlebitis (or commonly, phlebitis). Patients often experience pain and tenderness on the surface of the leg with appearance of a tender lump or streak. Many times, patients recall a varicose vein in the same area prior to the phlebitis appearing. Varicose veins are a well-recognized risk factor for thrombophlebitis.

How do these blood clots develop?

Many factors have the potential to increase your risk of blood clots. Some of the common factors are an inherited blood clotting disorder, prolonged bed rest or immobility (chronic disease, injury or prolonged surgery, long flights), birth control pills, smoking, cancer, varicose veins and local leg trauma.

What are the risks associated with superficial thrombophlebitis?

While phlebitis confined to the surface veins does not pose the same serious risk as DVT, we know that some patients with phlebitis progress to DVT as that surface clot extends to the deep venous system. Since superficial clots and deep clots may co-exist, we often perform a venous duplex ultrasound examination to detail the extent of the process.

What treatment options are available at Capitol Vein & Laser Centers?

The goals of superficial phlebitis treatment are to reduce the pain, prevent clot extension and diagnose any underlying venous issue that may predispose to recurrent clot formation.

Initially, anti-inflammatory medications like ibuprofen are helpful. Symptom resolution may take several weeks. Extensive phlebitis, especially cases in which the surface blood clot is very close to the deep veins, may be treated with blood thinners such as Coumadin®, Xarelto®, Eliquis® or heparin. The anticoagulant medications can help prevent the surface clot from extending into the deep veins. Maintenance of normal activity is helpful.

Since varicose veins are commonly associated with superficial phlebitis, it is important to have a thorough evaluation of the venous system with respect to venous insufficiency (reflux). If we identify venous reflux as a cause of the phlebitis, we often will advise endovenous ablation of the saphenous vein to normalize venous flow. Ablation is done with the office-based procedures VNUS Closure, VenaSeal, or ClariVein and all of these procedures allow immediate return to normal activity. Associated surface varicosities are then removed with microphlebectomy, another office procedure allowing speedy return to normal activity.