Phlebitis and thrombophlebitis

Phlebitis Overview

Phlebitis -inflammation of a vein. Thrombophlebitis -a blood clot in the vein causes the inflammation. Thrombophlebitis usually occurs in leg veins, but it may occur in an arm. The thrombus (clot) in the vein causes pain and irritation and may block blood flow in the veins. Phlebitis can occur in both the surface (superficial) or deep veins.

Superficial phlebitisaffects veins on the skin surface. The condition is rarely serious and, with proper care, usually resolves rapidly. Sometimes people with superficial phlebitis also get deep vein thrombophlebitis, so a medical evaluation is necessary. Deep vein thrombophlebitisaffects the larger blood vessels deep in the legs.Blood clots(thrombi) can form, which may break off and travel to the lungs. This is a potentially life-threatening condition calledpulmonary embolism

Causes Phlebitis may occur spontaneously or as a complication of a medical procedure. Local trauma and injury to a vein also increase the risk of forming a blood clot

Superficial phlebitisThere is usually a slow onset of a tender red area along the superficial veins on the skin. A long, thin red area may be seen as the inflammation follows the path of a superficial vein. This area may feel hard, warm, and tender. The skin around the vein may be itchy and swollen. The area may begin to throb or burn. Symptoms may be worse when the leg is lowered, especially when first getting out of bed in the morning. A low-gradefevermay occur.

Sometimes phlebitis may occur at the site where a peripheral intravenous (IV) line was started. The surrounding area may be sore and tender along the vein. If an infection is present, symptoms may include redness, fever, pain, swelling, or breakdown of the skin.

Thrombophlebitis migrans can be a non-metastaticmanifestation of malignancies such aspancreatic carcinoma

Deep vein thrombophlebitisThis can be similar in presentation to superficial phlebitis, but some people may have no symptoms.The classic signs and symptoms include redness, warmth, swelling, and pain in the leg. One may have pain and swelling throughout the entire limb.

TreatmentIn general, treatment may include support stockings and wraps to reduce discomfort as well as medications such as:AnalgesicsAntibiotics (if infection is present)Anticoagulants (blood thinners) to prevent new clots from forming

:Elevate the affected area to reduce swelling.Keep pressure off of the area to reduce pain and decrease the risk of further damage.Apply moist heat to reduce inflammation and pain.Surgicalremoval, stripping, or bypass of the vein is rarely needed but may be recommended in some situations.

RISK FACTORSOlder age (> 40 years)Male genderSmokingDiabetes mellitusHyperlipidemiaHypertensionHyperhomocysteinemiaWhen risk factors coexist, the risk increases several-fold

Symptoms Most asymptomatic Intermittant claudicationRest painUlcers and gangrene

INTERMITTENT CLAUDICATION (LEG ATTACK)

Derived from the Latin word claudicatio i.e. to limpCaused by PAD in the lower extremitiesCharacterized by pain, ache, cramp, tightness or sense of fatigue in leg muscles with activity Symptoms relieved by rest Results in reduced mobility and quality of life

WHAT CAUSES INTERMITTENT CLAUDICATION?

Atherosclerosis in peripheral arteries of legs

During exercise, oxygen demand increases

Muscles operate anaerobically

Produce lactic acid and other metabolites

Leg painLactic acid and other metabolites washed away on rest

INTERMITTENT CLAUDICATION IS INDICATIVE OF SYSTEMIC ATHEROSCLEROSIS40-60% of patients with intermittent claudication have concomitant CAD

PRIMARY SITES OF INVOLVEMENTFemoral & Popliteal arteries: 80-90%

Tibial & Peroneal arteries: 40-50%

Aorta & Iliac arteries: 30%

DIAGNOSISHistory takingCareful examination of legPulse evaluationAnkle-brachial index (ABI):SBP in ankle (dorsalis pedis and posterior tibial arteries)___________________________________SBP in upper arm (brachial artery)

WHY IS IT NECESSARY TO TREAT INTERMITTENT CLAUDICATION ?

Symptoms worsen in 25% of patientsApproximately 5% will require amputation within 5 yearsAround 5-10% have critical limb ischemia; risk of limb loss

GOALS OF TREATMENTTo relieve exertional symptoms and improve walking capacityTo improve quality of lifeTo reduce total mortality as well as cardiac and cerebrovascular morbidity and mortality

MANAGEMENTRisk factor modificationExercise therapyAntiplatelet therapyMedical therapy targeted at symptomsRevascularisation proceduresAmputation needed in some cases

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