Introduction

Description of the condition

Superficial thrombophlebitis is the abnormal and uncontrolled coagulation of blood in the veins of the superficial system, leading to their complete or partial closure. As a result, blood flow is either blocked or significantly restricted. The mere existence of a thrombus in a venous vessel also intensifies the inflammatory reaction, which is all the more distressing for the patient the larger the volume of the thrombus (i.e. the larger the vessel has become occluded). The nerves and lymphatic vessels (draining lymph from the subcutaneous tissue) adjacent to the veins are involved in the entire inflammatory reaction that develops in the vessel lumen and wall (the thrombophlebitis) and around the inflamed venous vessel. perithrombophlebitis). Thrombosis in superficial vein thrombophlebitis can progress either upwards (ascending) or downwards (descending).

The onset of symptoms is often preceded by trauma to the area where the thrombophlebitis develops, sometimes inflammation and swelling of the skin and subcutaneous tissue itself (e.g. after a cut or insect bite) may be the provoking factor. Superficial thrombophlebitis, especially recurrent thrombophlebitis, can also be one of the symptoms of cancer.

Symptoms of disease are usually acute, and often occur in an area where there was already a previous presence of, for example, varicose-lesioned vessels. Approximately 60% cases of thrombophlebitis involve the subcutaneous branches of the large veins of the superficial system, just over half (53%) involve the trunk of the saphenous vein, and nearly 15% involve the trunk of the saphenous vein. Significantly, nearly 25% cases of superficial thrombophlebitis run concomitant with deep vein thrombosis.

Mechanism of formation

The initiating factor for superficial thrombophlebitis is usually damage to the inner surface of the vessel wall. This can be caused by mechanical trauma or, for example, by the action of an irritant (e.g. chemical). An important prerequisite for the occurrence of thrombophlebitis is abnormal (too slow) blood flow in the vessel, caused, for example, by long immobilisation or prolonged local compression.

Recognition and diagnosis

Diagnostics superficial thrombophlebitis is based on several key elements. These are based on a characteristic clinical picture including reddening of the skin over the involved vein, a palpable, firm and painful venous return, localised temperature increase and swelling of the surrounding tissues. Patients usually report pain spontaneously and increasing on touch, as well as a feeling of tension in the affected area.

The diagnostic process begins with a detailed medical history, during which information is collected on the onset and development of symptoms, risk factors, co-morbidities, past treatments and family history of thrombotic diseases. Particular attention is paid to medications used, especially hormonal contraceptives and anticoagulants.

The gold standard for the diagnosis of superficial thrombophlebitis is the Doppler ultrasound examination. Doppler ultrasound allows precise localisation of the thrombus, determination of its extent and, unusually, exclusion of concomitant deep vein thrombosis (this is more common when the thrombus is located near the junction of the saphenous or saphenous vein with the deep system vein). On ultrasound examination, the characteristic features are incompressibility of the vein, the presence of echogenic material in the lumen of the vein, thickening of the vessel wall and absence of flow or residual flow.

Laboratory diagnostics includes basic investigations such as blood count, determination of the D-dimers (which are usually elevated) and CRP - as a marker of inflammation. In selected cases, especially when thrombophilia or other systemic diseases are suspected, extended tests are performed, including diagnosis for thrombophilia or the presence of antiphospholipid antibodies.

Recognition superficial thrombophlebitis requires three criteria to be met: a characteristic clinical picture, confirmation by Doppler ultrasound and exclusion of other pathologies. W differential diagnosis consider: subcutaneous tissue inflammation, deep vein thrombosis, vasculitis, erythema nodosum, post-traumatic lesions and neoplastic processes.

Monitoring of the course of the disease is based on follow-up venous Doppler ultrasound examinations, clinical assessment and control of laboratory parameters. The first follow-up should take place after 7-21 days, with subsequent follow-ups depending on the dynamics of the process, the treatment applied and the presence of risk factors. Particular attention should be paid to situations such as' rapid worsening of symptoms, spreading of lesions or appearance of general symptoms that may suggest the development of complications.

A correct and prompt diagnosis of superficial thrombophlebitis is key to implementing appropriate treatment and preventing potential complications, including the most serious one. deep vein thrombosis. The diagnostic process should be led by an experienced physician, preferably a specialist in vascular disease (phlebologist, angiologist, vascular surgeon).

Treatment methods

In the vast majority of patients with superficial thrombophlebitis, treatment with a non-steroidal anti-inflammatory drugs (NSAIDs), applied topically and, in the early stages of treatment, also orally. The following are helpful gels containing heparin or hirudinin extensive inflammation (and in concomitant deep vein thrombosis) - also heparin preparations administered subcutaneously or oral anticoagulants. Antibiotic treatment is only justified in rare cases, where the bacterial background of thrombophlebitis has been confirmed.

For large thrombophlebitis, treatment time can be significantly reduced by surgical or endovascular removal of thrombotic material from the vessel. An important adjunct to pharmacological treatment in superficial venous thrombophlebitis is the use of compression garments (so-called compression therapy). In addition to preventing secondary thrombotic complications, compression stockings or knee-length socks improve patient comfort by, among other things, reducing swelling and pain, and accelerate recanalisation (dissolution) of thrombotic lesions.

Adherence to preventive recommendations, such as regular physical activity, maintaining a healthy body weight and adequate hydration, is also crucial for optimal treatment results. In the event of intense pain in the limb, significant swelling, redness of the skin or increased body temperature at the site of the varicose vein, a phlebologist should be consulted immediately, who will perform a emergency venous Doppler ultrasound examination.

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