Thrombophlebitis and varicothrombosis: when to treat and how?

Thrombophlebitis is generally defined as thrombosis and inflammation of the superficial veins and surrounding tissues. Since its pathophysiological and histological characteristics are similar to those of deep venous thrombosis, latterly it has also been referred to as superficial venous thrombosis (SVT). A distinction is drawn between SVT in primarily healthy veins (thrombophlebitis) and varicothrombosis, where thrombosis occurs in a varicose vein. SVT is a common disease with a prevalence of 5.3%. In 90% of cases, it occurs in the lower extremities and in up to 30% of cases is associated with a deep venous thrombosis, more rarely with a pulmonary embolism. A few cases have also been described, in which deep venous thromboses are found in several locations at the same time. For this reason, the initial diagnostic workup should always include duplex ultrasound to enable the exact location and extent of the thrombosis to be determined. Therapy depends on the location and extent of the SVT. Treatment options include both conservative and surgical measures. The only drug approved for the treatment of SVT is fondaparinux. Low molecular weight heparins are effective. Because SVT can be the consequence of a serious underlying condition, screening for cancer should be considered, if thrombophlebitis is suspected or in cases of recurrent varicothrombosis, and screening for thrombophilia possibly carried out in younger patients.