Superficial vein thrombosis
Superficial vein thrombosis occurs when a thrombus forms within a superficial vein and causes inflammation of the vessel wall. For a list of major superficial veins of the lower and upper limbs, see Major deep and superficial veins of the lower and upper limbs.
Superficial vein thrombosis is usually self-limiting; however, it can be complicated by venous thromboembolism (VTE) (ie deep vein thrombosis [DVT] or pulmonary embolism [PE]), particularly if the patient has risk factors that are common to both superficial vein thrombosis and VTE (eg cancer, pregnancy). Superficial vein thrombosis can also be complicated by thrombus extensionThrombosis Canada, 2021.
Conditions associated with superficial vein thrombosis are intravenous cannulation, pregnancy, active cancer1, varicose veins, and other causes of venous stasis and venous trauma.
A compression ultrasound is suggested for diagnosis, particularly for patients with risk factors for VTE (such as those listed in Risk factors for VTE in nonsurgical patients in hospital). The ultrasound determines the length of the thrombus and the proximity to the deep venous system, and excludes concurrent DVT. Approximately 25% of patients diagnosed with superficial vein thrombosis have a concomitant DVTThrombosis Canada, 2021.
Antibiotics are not indicated for superficial vein thrombosis unless the patient has septic vein thrombosis (septic thrombophlebitis) or an associated bacteraemia, which is the most common in patients with a history of recent venous cannulation – see Infections associated with intravenous catheters.
Management of superficial vein thrombosis depends on whether the risk of extension to a proximal DVT or PE is low, intermediate or high. Low molecular weight heparin (LMWH), fondaparinux, rivaroxaban and NSAIDs have been shown to reduce extension or recurrence of superficial vein thrombosis. However, at the time of writing, data to guide the prevention of extension or recurrence of superficial vein thrombosis are lacking and there is debate as to the most appropriate management strategyDi Nisio, 2020.