Superficial venous thrombosis
What is superficial venous thrombosis
Superficial venous thrombosis or thrombophlebitis is a condition of the superficial venous system characterized by inflammation of the vascular wall with the formation of intraluminal thrombi. Thrombus formation most commonly occurs in the saphenous vein (lower limbs) and it can be a complication of pre-existing varicose veins.
Causes of venous thrombosis
The fluidity of the blood is ensured by the balance between the procoagulant and the anticoagulant system, the state of the vascular endothelium (the integrity of the internal venous envelope) but also the active laminar flow. Factors that can affect this balance are responsible for the occurrence of thrombotic episodes of both superficial and deep veins:
- Congenital or acquired thrombophilias;
- Deficiency of low C and S protein coagulation inhibitors;
- Functional defects of the fibrinolytic system - dysfibrinogenemia, mutation of the gene responsible for the normal secretion of prothrombin;
- Gynaecological or lower limb or pelvic surgery followed by prolonged immobilization;
- Administration of estrogen-based contraceptives;
- Pregnancy, childbirth and childbed/confinement involve hormonal changes with decreased blood fibrinolytic activity;
- Injuries to the venous wall following intravenous administration of irritants;
- The trauma of pre-existing varicose veins.
Structural changes in the venous wall, slowing of blood flow and valvular incompetence are the pathological mechanisms that contribute to thrombophlebitis more frequently in people with associated risk factors: smokers, overweight, sedentary and those aged 40-60 years.
How the disease manifests itself
The location of superficial venous thrombosis is more common in the lower limbs, but it can also affect the external genitalia, or the mammary gland (Mondor's disease). The disease begins with the subtegumentary appearance of an erythematous, hard, irregular, painful "cord" that is due to inflammation and thrombosis of the affected vessel. Pain and discomfort may be spontaneous or when we reach the area served by the obstructed vein, and the oedema is often accompanied by an increase in local skin temperature.
If the thrombosis extends deep (deep thrombophlebitis) there is a destruction of the valvular venous structures with difficulty in venous return, stasis and edema accompanied by continuous pain more frequently in the lower limbs, a situation in which we talk about chronic venous damage.
Treatment of superficial venous thrombosis
External compression with the help of socks or medical phases that exert continuous pressure throughout daily activities has the role of replacing deficient valvular venous activity by reducing stasis and preventing the formation of thrombosis.
The medication used is generally anticoagulant - low molecular weight heparin or other drugs such as coumarin anticoagulants to maintain blood flow and nonsteroidal anti-inflammatory drugs to reduce discomfort and pain, being useful to combine local topics based on heparin. The drugs administered have the role of reducing symptoms, preventing the spread of pathological processes in depth (prevent deep vein thrombosis) and decreasing the recurrence of thrombosis (prevents the formation of new blood clots).
Surgical treatment is phlebectomy and is performed if the anticoagulant treatment (oral or injectable) is not effective with the risk of migration of intravenous thrombi into the pulmonary veins (through the collateral circulation) with the onset of severe acute ischemic episodes (pulmonary thromboembolism).