Thrombophlebitis

Thrombophlebities is often the result of surgical intervention, traumatic injury or immobility for prolonged periods.

Types

Different types of thrombophlebitis occur:

Superficial vein thrombophelbitis

The affected vein location is nearer to the surface of the skin is termed as superficial vein thrombophlebitis. This is less harmful and painless. The inflammation occurs just beneath the skin. The clot is easily breakable as they can circulate through blood. Rarely the symptoms are similar like deep vein thrombophlebitis.

Deep vein thrombophlebitis

Deep vein thrombophelbitis is located within the muscle and causes serious health issues, as it can cause permanent damage to the affected vein. The lower limb vein is usually affected. The clot can travel from affected site to other sites and may lead fatal condition. This condition occurs when the clot reaches to pulmonary artery and causes pulmonary embolism.

Migratory thrombophlebitis

In this type of thrombophlebitis, the clot is travel from one leg to other leg. Migratory thrombophebitis is also termed as Trousseau’s sign of malignancy. The term comes due to migratory thrombophebitis associated with adenocarcinoma present in the pancreas and lungs.

It has association with adenocarcinoma of the pancreas and lung; therefore, the history should be directed toward finding malignancy.

Septic thr0mbophelebitis

This condition is connected with venous thrmbophelebitis occurs due to bacterium attacks. Perivascular inflammation is a prominent symptom and pus may or may not secrete from venous lumen. The diagnosis need to culture the pus if secreted, other alternative method is radiographic examination. The treatment should be started as early as diagnosis is confirmed. Through intravenous injection, antibiotic therapy is given and if needed surgical intervention is required.

Symptoms of  thrmbophelebitis

Following are the common symptoms for thrmbophlebitis

• The affected area become tender and warmth is felt
• Painful
• Body temperature increases
• In case of lower limb become affected the ankle joint
• Sidewise inflammation of the leg is common.
• Foot of the leg become swallow

In case of superficial vein thrombophlebitis, the following symptoms are common:

• The affected skin surface become hard and tender
• The affected skin colour change to red

For deep vein thrombophlebitis, the above mentioned symptoms may noticeable, but most of the time they are asymptomatic, but during walking or standing, symptoms are prominent.

In case of deep vein thrombophlebitis, the chances of movement of the clotting are possible and if it happens, then clot may stuck in heart or lungs and causes an embolism. In embolism, the affected blood vessels become obstructed and provide the following symptoms:

• Tachycardia (heart rate become increased)
• Breathing distress
• Chest pain

Arises of above symptoms require urgent medical help, because wrong dislodgment of the clot become fatal.

Causes

Different reasons are responsible for thrombophlebitis, these are as follows:

• Flow of blood is not follow the proper path through the lower limbs vein
• Prolong sitting during travelling by airlines or road travelling cause blood become still and clotted
• Prolonged lying position after major surgery or illness also causes clotting
• Stretching of vein which arises in varicose vein also leads to thrombophlebitis.
• Thrombophelibitis is the complication of administration of IV tubes. To minimize this complication healthcare staffs frequently change the site of the IV lines.
• After child birth, mother may develop thrombophlebities.

Risk factors

• Malignancy
• Hormonal therapy
• Increase age above 60 years
• Obesity
• Smoking
• Family history of blood coagulation disorder

Diagnosis

• The changes occur in the appearance of the affected site and the discussion about the symptoms can easy to identify the thrombophlebitis.
• Vital sign checking including blood pressure and pulse rate help to identify thrombophlebitis
• For confirming the affected blood vessels, doctors conduct ultrasound which provides images in computer screen by using sound waves. This helps to locate the clot and affected blood vessels.
• Venogram is performed, if the clot is present at knees which are termed as blind spot and unable to get images through ultrasound. In this test, dye is administered through IV route into the foot. The X-ray images provide the internal picture of the vein.
• Blood test for D-dimer is conducted. D-dimer is synthesized when coagulated blood is broken down. In case of thrmobophlebitis, the negative test result is obtained.

Treatment

According to the severity the treatment of thrmbophelebitis varies.

• Superficial blood vessel can be treated by blood thinning medication like aspirin or ibuprofen. These drugs are available as OTC products and condition will be resolved within 15 days.
• Stockings or pressure bandage application to the leg helps to reduce inflammation.
• Leg elevation also helps to prevent fluid accumulation.
• In severe cases, admission in hospital is required and IV administration of heparin or low-molecular weight heparin can be given.
• After discharge of the patient for further prevention warferin is prescribed and continue this therapy for several months. Rutine blood test is conducted for monitor the improvement of the condition.
• Some novel blood thinning agents like rivaroxaban, apixaban, edoxaban and dabigatran are used for deep vein thrombosis. But these agents are rarely used, as they causes irreversible bleeding.
• To treat the associated infection, antibiotics also prescribed.
• Surgical intervention is also required in case of severe thrombophlebitis. This helps to bypass the clot.

Pictures

References

1. http://www.mayoclinic.org/diseases-conditions/thrombophlebitis/basics/causes/con-20021437
2. http://emedicine.medscape.com/article/463256-overview#a3
3. http://www.webmd.com/a-to-z-guides/understanding-thrombophlebitis-basics
4. http://www.webmd.boots.com/skin-problems-and-treatments/guide/thrombophlebitis?page=2
5. thrombophlebitis Symptoms, Diagnosis, Treatment at http://www.healthline.com/health/thrombophlebitis
6. http://www.webmd.com/a-to-z-guides/understanding-thrombophlebitis-treatment
7. Thrombophlebitis Symptoms, Causes, Treatment, Pictures at http://mddk.com/thrombophlebitis.html