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Thrombophlebitis

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Edema and Thrombophlebitis

Lymphedema and Thrombophlebitis

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Thrombophlebitis

Related Terms: blood clot, phlebitis, edema, vein obstruction, superficial thrombophlebitis, deep venous thrombosis, venous stasis, aseptic thrombophlebitis, septic thrombophlebitis, edema, lymphedema

Thrombophlebitis is an condition in which a blood clot and inflammation occurs in one or more veins close to the surface of the skin.  Generally this is referred to as a superficial thrombosis versus deep venous thrombosis. It is extremely important to accurately assess this condition because an estimated 30% of patients with thrombophlebitis are subsequently diagnosed with deep venous thrombosis, which is life threatening.

Aseptic Thrombophlebitis

The most common form of thrombophlebitis. Aseptic thrombophlebitis types include primary hypercoagulable states - disorders with measurable defects in the proteins of the coagulation and/or fibrinolytic systems and Secondary hypercoagulable states - clinical conditions with a risk of thrombosis.  Risk factors for aseptic thrombophlebitis are disorders that involve increased likelihood of blood clotting, infections, varicose veins, sitting or being immobilized for an extended period of time.

Septic Thrombophlebitis

More serious and potentially more life threatening form associated with either recent IV therapy (venous cannulation) or intravenous drug abuse.

Septic thrombophlebitis is an infected blood clot in a vein, which may be life-threatening. The effects of septic thrombophlebitis may include:(1)

Treatment is with intravenous antibiotics. These should be broad-spectrum until cultures confirm the causative organism(s). If possible, the affected vein should be tied off and removed surgically.

Etiology and General Risk Factors:

Conditions that cause susceptibility to thrombophlebitis include varicose veins, medical conditions that lead to sluggish blood flow, pregnancy, patients undergoing intravenous injections, infections, as well as individuals who are immobilized or bed ridden.  Other risk factors are the insertion of a vein catheter (pacemaker, chest port-a-cath), oral contraceptives and or hormone replacement medication, AIDS (lupus anticoagulant), Behcet disease, Buerger's disease, Mondor's Disease, blood type A, burns, chemotherapy,  congestive heart failure, age, proteins C and S deficiency, trauma, ulcerative colitis.

Lymphedema and Thrombophlebitis

Because of the fibrosis associated with lymphedema, the recurrent episodes of cellulitis and due to the compression of the vascular system, there is a higher than normal risk of developing thrombophlebitis and or deep venous thrombosis.  Your physician should regularly check venous flow in the lymphedema affected limb.

Clinical:

Pain in the area of the clotted vein, this may include tenderness to the touch

Redness of the surrounding or adjacent area

Swelling or edema in the surrounding skin

Complications:

The two most serious complications are pulmonary embolism and heart attack or stroke.  Other complications involve damage to the veins in the leg and subsequent permanent venous pooling or swelling (edema), varicose veins, vein obstruction and permanent discoloration of the skin in the affected area.

The complications of septic thrombophlebitis include sepsis, septicemia, septic pulmonary emboli, abscess formation, pneumonia.

Pathophysiology:

In the absence of a triggering event, neither venous stasis nor abnormal coagulability alone causes clinically important thrombosis, but vascular endothelial injury does reliably cause thrombus formation. The initiating injury triggers an inflammatory response that results in immediate platelet adhesion at the site of injury. Further platelet aggregation is mediated by thromboxane A2 and by thrombin. Platelet aggregation due to thromboxane A2 is inhibited reversibly by nonsteroidal anti-inflammatory agents and irreversibly by aspirin, but thrombin-mediated platelet aggregation is unaffected by aspirin and nonsteroidals. This is why aspirin and nonsteroidal anti-inflammatories are somewhat effective in preventing arterial thrombosis, including stroke and myocardial infarction, but they are not very effective in preventing or treating venous thrombophlebitis. (1)

Diagnosis:

With the clinical features involved it is often easy to diagnosis thrombophlebitis from symptoms and appearance alone.  However, because of the risk of deep venous thrombosis certain diagnostic tests become imperative.  These tests include radiology examinations which include venous imaging,  duplex ultrasound, magnetic resonance imaging, and invasive contrast venography, doppler study.

Other tests that may be used include the Perthese percussive test and the Trendelenburg test.

Differential Diagnosis:

Cellulitis, erythema nodosa, cutaneous polyarteritis nodosa, sarcoid, Kaposi's sarcoma, hyperanalgesic psuedothrombophlebitis

Treatment:

Treatments include medications (anti inflammatory medicine, anticoagulants), increased ambulation, compression stockings and focusing on causative factors (antibiotics for infections).  Other treatment modalities may include varicose vein stripping, insertion of a filter in the main vein in the abdomen (vena cava) and clot removal or bypass.

The edema associated with thrombophlebitis should subside upon treatment of the condition. If not, gentle decongestive therapy may be necessary.

Medications used in treatment might include IV heparin, warfarin, oxymetholone, antithrombin III, Stanozolol, ethylestrenol.  Medications will be based on underling or complication medical conditions, type and severity of thrombophlebitis, whether aseptic or septic.

Prevention:

There are preventative measure that can be undertaken to lessen the likelihood of thrombophlebitis, these include

One long trips, getting up and walking around to keep circulation flowing

If walking around is not possible, keep moving your legs, flexing the leg muscles

Support garments that help promote fluid circulation and prevent edema 

Aspirin therapy may be prescribed.  Aspirin affects the blood's clotting ability and can help prevent vascular coagulation

Prognosis:

Dependant upon the severity and underlying medical cause.  Usually is quite good and the patient  (in uncomplicated cases) should be relieved of symptoms from two to six weeks.  Death from aseptic thrombophlebitis is rare.

For septic thrombophlebitis the mortality rates can be high if the condition is left untreated.

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Superficial Thrombophlebitis (ST)

What is superficial thrombophlebitis?

Superficial thrombophlebitis (ST, or SVT) is a condition in which inflammation causes a blood clot to form in a vein near the surface of the body. Often it develops in varicose veins, usually in the leg, pelvis, or arm. Varicose veins are enlarged veins close to the surface.

How does it occur?

ST occurs when irritation of a vein causes blood flow to slow down or stop, and a clot then forms in the vein. ST can occur after minor injury to a vein, for example, after a bruise or after you have had an IV (medicine or fluid given through a vein). It can also occur after excessive exercise.

What are the symptoms?

Symptoms of superficial thrombophlebitis may include:

How is it diagnosed?

Your health care provider will ask about your symptoms and examine you. He or she will be able to determine if you have ST from the physical exam. In some cases you may have special ultrasound or x-ray studies to check for clots in deeper veins.

How is it treated?

For treatment, your health care provider may recommend that you:

How long will the effects last?

With proper treatment, ST usually lasts 1 to 2 weeks.

How can I take care of myself?

How can I help prevent ST?

Because ST usually results from injury, it is hard to prevent.

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University of Michigan Health System

http://surgery.med.umich.edu/vascular/patient/disease-specific/venous/thrombophlebitis.shtml

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For further information:

Thrombophlebitis

Medline Plus

http://www.nlm.nih.gov/medlineplus/thrombophlebitis.html

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Thrombophlebitis, Superficial (1)

eMedicine

http://knowledge.emedicine.com/cgi-bin/knijavascript.htm?va=thrombophlebitis%2C%20superficial

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Thrombophlebitis

AllRefer Health

http://health.allrefer.com/health/thrombophlebitis-info.html

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Septic Thrombophlebitis(1)

http://dermnetnz.org/reactions/iv-drug-abuse.html

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Medical Library



Atlas of the Body:

The Circulatory System Venous
 
Your veins carry blood back toward the heart. Tiny vessels called capillaries in organs and tissues of the body deliver deoxygenated blood into small veins called venules, which join to form veins. Blood flows through the veins to the body's two main veins (called the vena cavae), which deliver the blood back into the heart 
 
Circulatory System-Venous

Source: AMA's Current Procedural Terminology, Revised 1998 Edition. CPT is a trademark of the American Medical Association.

http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZG57C56JC&sub_cat=510

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See also:

Comparison of Edema versus Lymphedema

http://www.lymphedemapeople.com/thesite/edema_or_lymphedema.htm

Edema and Chronic Venous Insufficiency

http://www.lymphedemapeople.com/thesite/edema_chronic_venous_insufficiency.htm

Edema and Deep Venous Thrombosis

http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thrombosis.htm

Edema and Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

http://www.lymphedemapeople.com/thesite/edema_and_reflex_sympathetic_dystrophy.htm

Edema and Venous Pooling

http://www.lymphedemapeople.com/thesite/edema_and_venous_pooling.htm

Edema and Angioedema

http://www.lymphedemapeople.com/thesite/edema_angioedema.htm

Edema of the Neck

http://www.lymphedemapeople.com/thesite/lymphedema_of_the_neck.htm

Edema and Nephrotic Syndrome

http://www.lymphedemapeople.com/thesite/edema_nephrotic_syndrome.htm

Edema of the Face

http://www.lymphedemapeople.com/thesite/edema_of_the_face.htm

Edema and Diabetes

http://www.lymphedemapeople.com/thesite/lymphedema_and_diabetes.htm

Edema and Congestive Heart Failure

http://www.lymphedemapeople.com/thesite/lymphedema_and_congestive_heart_failure.htm

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

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No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

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If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

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Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

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Lymphedema People

Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

......................

Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

......................

All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

......................

Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

......................

All About Lymphedema

For our Google fans, we have just created this online support group in Google Groups:

Homepage: http://groups-beta.google.com/group/All-About-Lymphedema

Group email: All-About-Lymphedema@googlegroups.com

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Lymphedema Friends

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If you an AOL fan and looking for a support group in AOL Groups, come and join us there.

Updated Dec. 23, 2011