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 phlebitis affects 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 thrombophlebitis affects 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 called pulmonary
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 phlebitis
• There 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-grade fever may 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-
metastatic manifestation of malignancies such
as pancreatic carcinoma
• Deep vein thrombophlebitis
• This 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.
• Treatment
• In general, treatment may include support
stockings and wraps to reduce discomfort as
well as medications such as:
• Analgesics
• Antibiotics (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.
• Surgical removal, stripping, or bypass of the
vein is rarely needed but may be
recommended in some situations.
 RISK FACTORS
• Older age (> 40 years)
• Male gender
• Smoking
• Diabetes mellitus
• Hyperlipidemia
• Hypertension
• Hyperhomocysteinemia

When risk factors coexist, the risk increases

several-fold
 Symptoms

• Most asymptomatic
• Intermittant claudication
• Rest pain
• Ulcers and gangrene
INTERMITTENT CLAUDICATION (LEG ATTACK)

• Derived from the Latin word claudicatio i.e. “to

limp”
• Caused by PAD in the lower extremities
• Characterized 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 pain
• Lactic acid and other metabolites washed away on
rest
 INTERMITTENT CLAUDICATION IS INDICATIVE
OF SYSTEMIC ATHEROSCLEROSIS

• 40-60% of patients with intermittent claudication

have concomitant CAD
 PRIMARY SITES OF
INVOLVEMENT
Femoral & Popliteal
arteries: 80-90%

Tibial & Peroneal

arteries: 40-50%

Aorta & Iliac arteries:

30%
 DIAGNOSIS
• History taking
• Careful examination of leg
• Pulse evaluation
• Ankle-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 patients

• Approximately 5% will require
amputation within 5 years
• Around 5-10% have critical limb
ischemia; risk of limb loss
 GOALS OF TREATMENT
• To relieve exertional symptoms and
improve walking capacity
• To improve quality of life
• To reduce total mortality as well as
cardiac and cerebrovascular morbidity
and mortality
 MANAGEMENT
• Risk factor modification
• Exercise therapy
• Antiplatelet therapy
• Medical therapy targeted at symptoms
• Revascularisation procedures
• Amputation needed in some cases
Thank you …